Assistant General Counsel for Health Plan Operations

Overview

The Assistant General Counsel for Health Plan Operations serves as a key legal partner to health plan operations, providing practical, business-minded counsel across the full range of activities that support Medicare Advantage and related products. This individual contributor role reports to the Deputy General Counsel and supports claims, network development and management, provider contracting, delegated entity oversight, and regulatory compliance. The role involves translating a complex and evolving legal landscape into actionable guidance for business and clinical teams.

Responsibilities

• Advise on claims adjudication, payment integrity, appeals, and related legal and regulatory requirements.
• Support network development and management teams on provider contracting, provider relationships, credentialing, and operational matters.
• Collaborate with compliance to ensure adherence to state regulatory requirements and advise on compliance with state and federal health care laws and regulations.
• Provide counsel on delegation arrangements with third parties, including TPAs, PBMs, behavioral health vendors, and other delegated entities.
• Support delegated entity oversight programs, including compliance monitoring, remediation, and regulatory reporting obligations.
• Interpret new and evolving regulatory guidance and translate it into actionable recommendations for business and clinical teams.
• Assist with regulatory exams, audits, and inquiries from state departments of insurance and other regulatory agencies.
• Support legally compliant implementation of clinical programs, quality initiatives, and utilization controls.
• Collaborate with cross-functional teams and business leaders to review legal issues and implications of potential business decisions and initiatives.

Requirements

• Licensed to practice law in at least one state.
• Eight to ten (8–10) years of legal experience, including a minimum of two to four (2–4) years of in-house experience.
• Prior in-house experience at a health plan.
• Knowledge of health care regulatory requirements applicable to health plan operations, including claims, provider contracting, delegation and delegated entity oversight, and state and federal health care laws and regulations.
• Strong business acumen with the ability to analyze legal issues from a business perspective.
• Proven ability to manage complex issues, meet regulatory deadlines, anticipate requirements proactively, and build strong collaborative relationships with regulators and internal partners.
• Excellent interpersonal, organizational, and communication skills, including effective oral and written presentation.
• Proactive, solutions-oriented mindset with the ability to navigate ambiguity and scale legal processes in a growing organization.
• High level of personal integrity, professionalism, intellectual curiosity, and willingness to grow.
• Ability to manage multiple varied tasks and assignments efficiently and effectively to meet deadlines with urgency.

Preferred Qualifications

• Prior in-house experience with a Medicare Advantage plan is highly desirable but not required.

Compensation & Benefits

• Salary range: $175,000 - $225,000 per year plus equity.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for all roles excluding Director and above; commission eligibility for sales roles.
• Parental leave program.
• 401(k) program.

Note: The total rewards package is available to full-time employees only. Intern and contract positions are not eligible.

Location

Not specified.