Development Analyst III
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Kansas • Montana • United States
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Salary
💰 $70,100 - $126,200 per year
About the role
- Responsible for creation of member contract documents, including Evidence of Coverage (EOC) and related documents, for commercial products for high risk states
- Independently performs regulatory and operational research related to EOC and benefit development
- Conducts risk assessments, including impact to member contract documentation and downstream output
- Monitors pending legislation and regulations affecting Centene's commercial product in high risk states
- Provides updates to relevant member contract documents and provides the business with recommended changes
- Performs detailed language analysis of the Ambetter/Commercial Evidence of Coverage (EOC) and other relevant member materials
- Ensures quality control, compliance with State and Federal regulations as well as organizational standards
- Leads initiatives related to these activities
- Drafts and creates alternative language to include in regulatory member materials
- Conducts research projects to provide guidance on legal, contractual and regulatory requirements for assigned states
- Seeks to resolve member contract documentation issues which may negatively impact service to members
- Serves as a Subject Matter Expert within depth knowledge of health insurance products, procedures, and regulations
- Analyzes pending legislation and regulations affecting Centene’s commercial product related to member materials
- Provides recommendations to the business regarding changes needed to member contractual documents
- Performs risk assessment of member contractual materials related to passed and proposed legislation in high risk states
- Assists in developing junior employees and maintains/updates training materials
- Leads updates and maintenance of Policies and Procedures, Work Plans and any department training materials
- Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market
- Creates, drafts, and revises filing documentation, including but not limited Evidence of Coverage and regulatory checklists
- Facilitates EOC review meetings with impacted departments to discuss recommended EOC revisions and language
- Reviews include multiple phases of research, drafting and coordinating of internal approvals
- Develops and presents communications with alternative viewpoints
- Builds persuasive arguments and secures cooperation of others
- Determines the appropriate approach to problem solving
- Analyzes and creates appropriate responses to questions from regulators related to filing documentation
Requirements
- Bachelor's Degree in Business, Communications, Pre-Law or related field or equivalent experience required
- Master's Degree in a related field or Jurisprudence (JD) preferred
- 3+ years regulatory experience including creation of regulatory documentation, policy analysis and product filings (CMS and/or State DOI) required
- 3+ years experience in commercial health insurance or a highly regulated industry required
- 3+ years experience drafting and auditing member contract documentation or related documents
- Experience analyzing legislation and/or regulations and conveying findings
- Understanding policy issues impacting the healthcare sector preferred
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
regulatory documentation creationpolicy analysisproduct filingsrisk assessmentlanguage analysiscontract documentation draftingregulatory researchEOC documentationcompliance monitoringtraining material development
Soft Skills
leadershipcommunicationproblem solvingpersuasioncollaborationanalytical thinkinginitiativeattention to detailadaptabilitymentoring
Certifications
Bachelor's DegreeMaster's DegreeJurisprudence (JD)