The purpose of this role is to manage, provide guidance to, and monitor the processes necessary to ensure regulatory compliance of administrative departments as relates to federal/local insurance regulatory requirements, including those required under the Patient Protection and Affordable Care Act (Health Care Reform) and Medicaid. The candidate filling this position shall participate in cross-functional teams responsible for the development and deployment of new/revised products and benefits in the region, and shall act as a resource to the MSBD and HPSA operational areas to address compliance or regulatory concerns. The role will also include conducting or participating in assessments of administrative business practices, as well as review of marketing and member communications for compliance w/ both federal and regional insurance regulations.
Essential Functions:
- Act as an expert for regional compliance w/ state/local insurance regulatory requirements that relate to EOCs and other member materials, working closely w/ PO Legal.
- Review for approval or revision proposed commercial, OPM (fed) and Medicaid marketing and other member materials, such as collateral materials, EOCs, plan documents provider directories.
- Also review proposed local legislation addressing insurance products.
- Participate in the regional implementation efforts of the ACA, including representing the region on national and regional committees.
- Create compliance tools, such as checklists and other documents, to assist administrative departments incorporate compliance requirements into their processes.
- Maintain a detailed and ongoing knowledge of local jurisdictional insurer/payor regulatory laws and regulations, as well as applicable federal laws to which the Region is subject. Examples include PPACA (Health Care Reform), COBRA, HIPAA Portability, and ERISA.
- Be the regional compliance contact w/ the MAS Medicaid Office related questions relating to insurance functions related to this line of business.
- Perform periodic probe audits and assessments of selected functions performed by business units to assess status of compliance w/ regulatory requirements.
- Train or assist w/ the training of new or existing staff on various aspects of regulatory compliance which relate to the various KP products.
- Chair ad hoc committees as necessary.
- Work w/ business units to review policies and procedures to document internal processes which support compliance w/ internal and regulatory requirements.
- Establish and/or maintain positive working relationships w/ the insurance regulators of Maryland, Virginia and the District of Columbia.
- Other duties as assigned.
Qualifications:
Basic Qualifications:
- Five (5) years of experience in a commercial health insurance product and/or health insurance product regulatory setting required, w/ a strong preference for such experience related to VA, MD and DC health care regulation (insurance experience related to life/casualty/property insurance, or IT/HIPAA/Security/financial compliance does not meet this threshold).
- Bachelor's degree required.
- Ability to successfully engage peers in self-managed teams to meet deadlines and to communicate successfully w/ senior leaders required.
- Ability to negotiate complex issues, and engage in conflict resolution as needed, w/ internal clients and w/ external groups is required.
- Excellent interpersonal skills and demonstrated oral and written communication skills are required.
Preferred Qualifications:
- Three (3) to five (5) years of project management experience preferred.
- Insurance or regulatory experience w/ PPACA is strongly preferred.
- Experience w/ auditing is preferred.
- Master's degree or JD preferred.
- CHC Certification preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.