Become a part of our caring community and help us put health first
 

The Senior Insurance Product Compliance Professional performs consultation and research for policy and certificate language development. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Insurance Product Compliance Professional negotiates with state and federal regulatory agencies to obtain approval of insurance policy and certificate forms; supports implementation and maintenance of compliant insurance product policies and certificates; and begins to influence departmental strategy through subject matter expertise. An associate in this role is expected to make independent decisions on moderately complex to complex technical issues regarding project components; operate with minimal direction, and exercise latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Responsibilities

• Monitor and analyze state/federal regulatory requirements to assess contract language impacts and provide consultative guidance to other associates within the team. Coordinate legislative updates between Group and Individual products where applicable.
• Collaborate with various teams regarding state/federal requirements that impact existing products, new products, and product refreshes.
• Create awareness of current regulatory issues and ensure compliance for new and existing policies, certificates, and other related forms.
• Write generic and/or state-specific group contract language for Specialty policies/certificates to support product initiatives, administrative practices, and regulatory requirements, including applicable readability standards.
• Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals.
• Research and develop written responses to or provide consultative support for regulatory objections, exams, and inquiries.
• Maintain accurate and thorough documentation regarding the rationale for new or revised contract language.
• Conduct quality reviews of generic and state-specific policy/certificate forms.
• Serve as Subject Matter Expert (SME) for assigned Specialty lines of business and/or topics, triage and answer compliance related questions regarding policy and certificate language.
• Assist Professional 2s with drafting state forms and understanding state and federal filing requirements.
• Work with Professional 2s to ensure information on project tracking tools is accurate and current.
• When needed, support product filings to include drafting, filing, and implementing production forms, including annual On-Exchange product filings/binders.
• Recommend and support process improvements to maximize efficiency.
• Draft or provide input to work instructions/process documentation.
• In conjunction with the Lead(s), provide training and support to new and existing associates as needed.
• Write and maintain ASO templates (Plan Management Agreement and Summary Plan Description) for assigned group Specialty product(s).
• Prepare standard policy and certificate forms for use as templates for state and federal regulatory filings and subsequent implementation.
• Research and provide responses to Request for Proposals (RFPs) and/or Pre-sale Quotes (PSQs).
• Consult on application filings issues and coordinate filing of applications for group and/or individual Specialty products.
• Conduct and/or assist with research requests.
• All other duties as assigned.

Required Qualifications

• Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function
• Minimum 5 years of healthcare / insurance industry experience
• Knowledge of laws and regulations governing the healthcare / insurance industry experience, such as state Departments of Insurance and CMS
• Ability to research and analyze state laws and regulations
• Understanding of insurance products, including policy/certificate language
• Proficient in Adobe Acrobat and Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint
• Excellent oral and written communication skills.  This includes ability to collaborate effectively with associates across all levels of the organization and reviewer-level state/federal regulators
• Demonstrated attention to detail and accuracy
• Proven analytical and problem solving ability
• Self-Motivated and task oriented, with an ability to manage multiple priorities and work under pressure to meet deadlines
• Must be passionate about contributing to an organization focused on e