Development Analyst III
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Kansas, Montana, South Dakota, Tennessee • 🇺🇸 United States
Visit company websiteSalary
💰 $70,100 - $126,200 per year
Job Level
Mid-LevelSenior
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
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)