Associate Exchange Compliance
Job Summary
The Associate, Exchange Compliance will lead operations and foster relationships with regulators at state-based insurance exchanges and CMS. This role bridges the gap between regulators and company operations to ensure regulatory changes and operational adjustments are implemented effectively. Responsibilities include enforcing policies, conducting regular audits, and managing technical action items to ensure full compliance.
Responsibilities
- Manage regulatory relationships and operations
- Conduct internal and external audits
- Develop and implement compliance improvement plans
- Lead exchange-related calls and tracking deliverables
Required Skills
- Health plan compliance experience
- Expertise in CMS and State DOI regulations
- Project management skills
- Stakeholder communication
Job Details
Responsibilities:
- Partner with all relevant departments to ensure current compliance levels.
- Provide training to team members regarding regulatory compliance.
- Ensure that all team members are aware of the procedures to be followed to meet compliance requirements.
- Develop and implement compliance improvement plans where required.
- Delegate tasks to other departments to bring compliance levels up.
- Develop reports, where necessary, to the governing body.
- Assist Regulatory Authorities with completing site visits and external audits.
- Prepare for, and conduct audits alongside external authorities.
- Conduct regular audits in all required areas to ensure compliance.
- Support account management for CMS and state-based exchange regulators, and manage main technical and operational action items.
- Escalate complex operational and technical issues and questions to regulators while maintaining compliance.
- Be the lead contact on all exchange calls and requests.
- Help build a standard set of processes for teams to track dependencies, deliverables, and product/feature launches.
- Work collaboratively with multiple teams to ensure compliance with all applicable laws and regulations.
Requirements:
- Bachelor's Degree or equivalent work experience.
- 1+ year experience in health plan compliance.
- 2+ years experience with State DOI health insurance rules and regulations, CMS ACA rules and requirements, and CMS requirements.
- 2+ years experience managing high volume and complicated projects, keeping track of details, and staging work to deliver projects on time.
Bonus points:
- CHC, CCEC, or similar certification.
- Fluency with State DOI audit and/or reporting obligations.
- State DOI audit management experience.
- Experience in a start-up and/or health tech environment.
- Experience in a TPA setting.
- Experience with state-based exchanges and the federally facilitated marketplace.
- Experience improving and designing processes.
- Experience attending external meetings with key regulatory staff.
- Experience presenting complex concepts to Senior Level staff for business decisions.