Regulatory Operations Business Analyst IV

This is a fully remote position, open to applicants in Florida, +6 more states.

📋 Description

• Complete federal and/or state application templates and documents for Qualified Health Plans (QHP), including policy forms for individual commercial marketplace products.

• Review and interpret application guidelines from the Departments of Insurance and CMS.

• Develop and implement auditing and monitoring strategies for states identified as high-risk.

• Prepare and oversee QHP templates and regulatory filing documents for HIOS and SERFF submissions.

• Ensure quality control, regulatory compliance, adherence to organizational standards, and alignment with internal operations, products, and financial arrangements.

• Mentor junior team members and support their career development.

• Audit QHP documents for states categorized as low-, medium-, and high-risk, and coordinate departmental audits.

• Develop and implement strategies for continuous improvement, audits, and quality initiatives.

• Lead the management, creation, auditing, and maintenance of Sources of Truth documents.

• Represent Regulatory Operations in cross-functional meetings and facilitate data reviews.

• Analyze federal and state legislation and regulatory orders to assess impacts and risks.

• Spearhead the implementation of new regulations and legislation, including updates to policy and filing documents.

• Oversee the onboarding and training of analysts while maintaining training materials.

• Coordinate and lead internal and cross-functional projects as a subject matter expert.

• Participate in external and virtual conferences and seminars to assess industry trends.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor's Degree in Business, Communications, Health Care, Political Science, or a related field is required.

• A Master's Degree in a related area is preferred.

• A minimum of 6 years of experience in business process or data analysis within health insurance, legal, compliance, or a related field is required.

• Experience in commercial health insurance and/or behavioral health managed care is preferred.

• Proficiency in drafting and auditing filing documentation, QHP Templates, or related areas is preferred.

• Experience in auditing databases or QHP filing documentation is preferred.

• Familiarity with analyzing legislation and/or regulations and effectively conveying findings is preferred.

• Knowledge of SERFF and HIOS systems is preferred.

• Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future.

• Must adhere to company policies and standards.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work options including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.