[Hiring] Regulatory Operations Business Analyst III @Centene Corporation

Role Description

Performs or assists with regulatory filings for medium/high risk states, seeking annual approval for individual commercial marketplace. Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for medium/high risk states, including policy forms for individual commercial marketplace products for low-risk states.

• Guides and conducts special projects.
• Reviews and provides interpretation of application instructions from regulatory agencies such as Department of Insurance (DOI) and Centers for Medicare & Medicaid Services (CMS).
• Assists in the development and implementation of auditing and monitoring strategies for medium/high-risk states.
• Performs root cause analysis to inform continuous improvement and special project development activities.
• The role is fully remote within the continental United States.
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• Oversees and prepares Qualified Health Plan templates and/or formal regulatory filing documents.
• Audits QHP documents for high-risk states ensuring compliance and accuracy.
• Actively manages and collaborates with Sources of Truth (SOT) document owners for QHP filing template and policy form development.
• Attends, engages, and represents the Regulatory Operations team in cross-functional meetings.
• Analyzes proposed and/or enacted federal and state legislation and/or regulatory orders.
• Leads implementation of passed legislation or new regulations impacting QHP scope of work.
• Takes ownership of team activities for maintenance, implementation, and continuous improvement of department policies.
• Assists with managing relationships with regulatory agencies (DOI and CMS).
• Leads onboarding of new employees and training of analysts on essential job duties.
• Coordinates and leads projects internal to the department as a subject matter expert.
• May attend external and/or virtual conferences and seminars to evaluate industry trends.
• Performs other duties as assigned. Complies with all policies and standards.

Qualifications

• Bachelor's Degree in Business, Communications, Health Care, Political Science or equivalent experience required.
• 4+ years business process or data analysis experience in health insurance, legal, compliance or related area required.
• Experience in commercial health insurance and/or behavioral health managed care preferred.
• Experience drafting and auditing filing documentation (Summary of Benefit Coverage, Schedule of Benefits, etc.) or QHP Templates preferred.
• Experience auditing database or QHP filing documentation preferred.
• Knowledge of SERFF and/or HIOS systems preferred.

Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship.

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.
• Total compensation may include additional forms of incentives.
• Benefits may be subject to program eligibility.

Company Description

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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.