Director of Regulatory Compliance – Large Group Health Insurance

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee regulatory activities for entry into new states, encompassing certificates of authority, insurer licensing, foreign qualification, and producer/agency licensing.

• Investigate and outline state-specific insurance requirements to guide expansion strategies.

• Create a standardized playbook for new-state licensing and filing processes.

• Collaborate with Actuarial on SERFF rate and form submissions, addressing DOI objections as needed.

• Monitor state filing deadlines, renewals, periodic reporting, and manage the master compliance calendar.

• Act as the main liaison with the Texas Department of Insurance and relevant state DOIs, as well as NAIC and CMS.

• Oversee regulatory examinations, market conduct assessments, inquiries, and complaint escalations.

• Stay updated on legislative and regulatory changes, translating these into business impact evaluations.

• Develop and uphold compliance policies, procedures, internal controls, and monitoring/testing initiatives.

• Collaborate with Legal and HR regarding producer and agent appointments, licensing, and training.

• Assist in regulatory and compliance risk management, including ORSA-related processes, risk registers, and leadership or Board reporting.

• Prepare compliance updates and risk assessments for executive leadership and the Board.

• Maintain documentation and audit trails that demonstrate compliance readiness.

• Provide guidance to Product and Actuarial teams on regulatory feasibility.

• Educate Claims, Member Services, and Sales teams on relevant regulatory requirements.

• Serve as an internal consultant to aid non-compliance teams in understanding regulatory responsibilities.

⛳️ Requirements

• A Bachelor's degree is required.

• 8+ years of progressively responsible experience in health insurance regulatory compliance, including direct experience with a fully insured commercial health carrier.

• Knowledge of health insurance regulatory reporting requirements such as Mental Health Parity, Prompt Pay, Market Conduct, Gold Card, Balance Billing, and Network Adequacy.

• Practical experience with state DOI rate/form filings and SERFF.

• Experience in supporting or leading multi-state licensing and market entry for an insurance carrier.

• Strong understanding of state insurance codes, NAIC model laws/regulations, and federal regulations applicable to fully insured group and individual health coverage, including ACA market reforms, HIPAA administrative simplification, COBRA, and ERISA as appropriate.

• Experience managing or responding to regulatory examinations and market conduct assessments.

• Exceptional written and verbal communication skills, with the ability to distill complex regulatory requirements into actionable business advice.

• Highly organized, self-motivated, and capable of taking significant ownership in a lean, fast-paced organization.

• Excellent time management and organizational capabilities.

• Must reside in the United States within the CST or EST time zones.

• Company business hours are weekdays from 9 AM to 5 PM CST.

• Must have a dedicated workspace separate from living areas to ensure information privacy.

• Ability to secure company-sensitive documents.

• Must be located in an area with high-speed internet service.

• Preferred, but not mandatory: experience in expanding a Texas-domiciled or Texas-licensed carrier; familiarity with the Texas Department of Insurance; building early-stage compliance functions; knowledge of network adequacy and provider contracting compliance; professional certifications such as CHC, CPCU, HIA, or AHIP; experience with fully insured group employer products; and ERM and ORSA-related reporting.

🏝️ Benefits

• Remote work position; the entire company operates remotely.

• Dedicated workspace allowance/requirement to ensure information privacy.

• Requirement for an existing high-speed internet connection/service.

• Company business hours are weekdays from 9 AM to 5 PM CST.