Under the direction of the Director, Regulatory Affairs, The Regulatory Manager, Commercial is responsible for achieving and overseeing enterprise compliance with relevant Federal and State guidelines, regulations, and contractual requirements and to assist with implementation of these requirements into internal operational functions and processes.
The position serves as one of several primary liaisons with key regulatory agencies and works collaboratively with other Healthfirst stakeholders as a resource to provide analysis and interpretation of regulatory policy guidance as it relates to the enterprise's commercial health insurance products.
Duties & Responsibilities:
- Coordinates and leads the development, preparation, and submission of regulatory reports and filing materials, including but not limited to, product Rate & Form filings in SERFF, and correspondence with various federal and state regulatory bodies.
- Serves as Subject Matter Expert on New York State commercial health insurance regulations, laws, and market dynamics. Works with appropriate business units to ensure timely review of submission materials and execution of necessary production revisions and changes.
- Researches, analyzes, and communicates regulatory requirements for operational units to ensure compliance with federal and/or state requirements. Recommends and/or facilitates the required steps to effectuate necessary changes.
- Works in conjunction with relevant departments to ensure newly enacted regulatory and statutory requirements are implemented within mandated time frames.
- Reviews and approves policies and procedures to ensure regulatory requirements are met.
- Reviews applicable company marketing materials to ensure compliance with relevant regulatory requirements.
- Consults with internal departments regarding regulatory issues while understanding the underlying root cause and applicable regulatory requirements, conducts analysis of risk, and recommends or initiates necessary corrective action.
- Serves as a point of contact for federal and state regulatory agencies on day-to-day issues.
- Responds to inquiries on regulatory issues. May represent the Regulatory Affairs department on committees and special projects.
- Supplies guidance to appropriate departments regarding the ongoing development and maintenance of the corporate web site. Ensures that any new federal and/or state requirements are implemented within required time frames.
- Provides support to all internal stakeholders, as needed, to assist with meeting various project deadlines and objectives.
- Identifies potential risk areas and develops or facilitates corrective actions to ensure continuing compliance.
- In collaboration with the Healthfirst Compliance department, oversees implementation and effectuation of all plans of correction developed for both internal and external audits.
- Works in collaboration with the Regulatory Audit Managers on all external agency audits/site visits, as necessary.
- Manages the company's processes related to out-of-network surprise bill independent dispute resolution cases.
- Must have a Bachelor's degree in a related field (political science, health sciences, economics, health policy, public health, natural sciences, public policy).
- Must have 3+ years' experience with a nalysis and interpretation of regulatory policy focused on commercial health insurance products
- Must have 3+ years' experience interpreting and summarizing federal and state health insurance laws and regulations.
- Must have 2+ years' experience submitting reports and regulatory filings through such portals as HIOS and SERFF
- Familiarity with and knowledge of the Affordable Care Act (federal health reform) and its implementation.
- Familiarity with New York State's commercial health insurance market dynamics and trends, including the NY State of Health Marketplace.
- Knowledge of and familiarity with health insurance exchange concepts and theories.
- Experience interacting with New York State and federal regulatory entities.
- Excellent written and verbal communication skills.
- Demonstrated ability to communicate clearly, succinctly and effectively.
- Ability to summarize complex materials/concepts/ideas in a clear and concise manner.
- Excellent analytical, editing, organizational and presentation skills.
- Master's degree in a related field.
- We can offer a hybrid work schedule consisting of reporting to office approximately twice a week (100 Church Street, NYC 10007)
Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.