Regulatory Operations Analyst III

Overview

This role involves reviewing, interpreting, and summarizing proposed and enacted legislation and regulatory updates as a subject matter expert on complex topics. The position performs state or federal policy research and regulatory change monitoring to support formal regulatory approval of Commercial/Marketplace products.

Responsibilities

• Identify, analyze, and interpret proposed or enacted legislation related to assigned products at the federal and state level; communicate findings to impacted departments.
• Independently perform risk assessments, including impact to business applications and downstream output.
• Maintain databases and other reference materials related to legislative and regulatory issues and compliance.
• Conduct comprehensive, complex regulatory analyses by reviewing, summarizing, and disseminating key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level.
• Lead regulatory interpretation related to Commercial/ACA rules and regulations and the commercial product; explain concepts clearly and adapt language and presentation based on the audience level.
• Provide guidance to the business as new regulations emerge.
• Use persuasive arguments to secure business cooperation in addressing potential legal, contractual, and/or regulatory issues; determine appropriate approaches for solving regulatory problems.
• Build trust-based relationships across varied audiences; collaborate with other functional areas to lead large projects and initiatives.
• Attend cross-departmental meetings as the departmental representative; provide guidance on regulatory requirements and appropriately escalate matters to management.
• Collaborate closely with internal departments, as well as Legal and Compliance, to develop solutions for potential legal, contractual, and/or regulatory issues.
• Support and manage relationships between health plans and regulatory agencies, including state and federal regulators.
• Independently draft responses to external requests for information needed for regulatory filings and/or policy needs.
• Maintain responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.
• Assess and analyze objections related to regulatory interpretation and lead drafting of appropriate responses provided to regulators related to commercial/ACA filings; partner with cross-functional teams as needed.
• Lead and support regulatory guardrails for new state entry and new product development; work closely with Legal on preparation of COA application materials/submissions for new states and/or products.
• Assist with developing and mentoring junior employees; support creation and revisions to training materials.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Bachelor’s Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required.
• Master’s Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred.
• 4+ years of experience in health insurance, legal, compliance, or related field required.
• Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred.
• Experience in commercial health insurance and/or behavioral health managed care preferred.

Compensation & Benefits

• Pay range: $70,100.00 - $126,200.00 per year.
• Comprehensive benefits package including 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.
• Actual pay will be adjusted based on skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Location / Scheduling / Work Authorization

• Working hours are CST (Central).
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, L-1, F-1, J-1, OPT, or CPT.

Equal Employment Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.