Regulatory Operations Analyst III

Centene Corporation; Michigan; Hybrid; USD 70,000 - 105,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation seeks a regulatory affairs professional to analyze and summarize legislation and regulatory updates impacting Commercial/Marketplace products. You will provide guidance to business units, assess regulatory requirements, and coordinate with legal, compliance and health plans to ensure filings and policy needs are met.

The role involves drafting responses for regulators, monitoring state and federal rules, and mentoring junior colleagues.

Qualifications

• Bachelor’s degree required in a relevant field (Business, Communications, Healthcare, Political Science/Pre-Law).
• Master’s degree or JD may be considered in place of experience.
• 4+ years experience in health insurance, legal, compliance or related field.

Responsibilities

• Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates for Commercial/ACA rules at state or federal level.
• Drafts responses and provides regulatory guidance to the business to address issues.
• Supports relationships between health plans and regulatory agencies; drafts information requests for filings and policy needs.
• Develops training materials and mentors junior staff; ensures compliance with policies and standards.

Skills

Regulatory analysis

Stakeholder management

Regulatory interpretation

Policy research

Clear communication

Education

Bachelor’s Degree in Business, Communications, Healthcare, Political Science/Pre-Law

Master’s Degree or JD may be considered in place of experience

Tools

Regulatory databases

Job description

Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of Commercial/Marketplace products.

Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Independently performs risk assessments, including impact to business applications and downstream output. Maintains database and other reference materials related to legislative and regulatory issues and compliance.

Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level. Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level. Provides advice to business as new regulations emerge.

Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues. Ability to determine appropriate approach for solving regulatory problems.

Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives. Attends cross-departmental meetings as department representative, provides guidance to the business related to regulatory requirements and appropriately escalates matters to management. Solutions to address potential legal, contractual and/or regulatory issues which arise working closely with internal departments as well as Legal and Compliance.

Support and manage relationships between health plans and regulatory agencies, including state and federal regulators. Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs.

Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.

Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings. Leads and supports regulatory guardrails for new state entry and new product development, working closely with legal on preparation of COA application materials/submissions for new states and/or products.

Assists in developing and mentorship of junior employees, supporting creation and revisions to training materials.

Complies with all policies and standards.

Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required. Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred.

4+ years experience in health insurance, legal, compliance or related field required.

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

You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.