Network Adequacy Manager: Compliance & Analytics

Insurance Department of the State of Georgia; Walnut Hills (OH); On-site; USD 75,000 - 100,000; Full time

Job summary

The Network Adequacy Manager at the Insurance Department of the State of Georgia ensures issuer compliance with federal and state network adequacy standards. This role serves as the primary authority for oversight of QHP and off-Exchange ACA plans, coordinating with staff, vendors, and external partners to maintain timely review cycles.

You will validate CMS, NBPP, and NAIC guidance, review provider networks for on- and off- Exchange plans, and produce quarterly analyses.

Qualifications

• Bachelor's degree in a related field; three years in a managerial role or seven years in the area with three in management.
• Experience in regulatory compliance and oversight activities.
• Knowledge of CMS NBPP and NAIC guidance is a plus.

Responsibilities

• Oversee analytical activities, supervise staff and vendor partners.
• Ensure timely and accurate review cycles and provide leadership updates.
• Interpret CMS NBPP and NAIC guidance to assess statewide impacts.
• Review issuer network adequacy submissions and evaluate provider network sufficiency.
• Draft, review, and approve deficiency notices and corrective action letters.
• Establish annual QHP certification timelines and coordinate with Georgia Access initiatives.

Skills

Management experience

Regulatory compliance

Education

Bachelor's degree in a related field

Job description

The Network Adequacy Manager at the Insurance Department of the State of Georgia ensures issuer compliance with federal and state network adequacy standards. This role serves as the primary authority for oversight of QHP and off-Exchange ACA plans, coordinating with staff, vendors, and external partners to maintain timely review cycles.

You will validate CMS, NBPP, and NAIC guidance, review provider networks for on- and off- Exchange plans, and produce quarterly analyses.