Senior Analyst Regulatory Strategy And Contracts

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Senior Analyst, Regulatory Strategy and Contracts
Duties: Responsible for development and drafting of (or similar) contracts and providing regulatory compliance consulting for fully insured line of business, ensuring customer satisfaction and compliance with contractual obligations, as well as alignment with business strategies and goals. This includes the development and administration of employer contracts, certificates of insurance, schedules of coverage, stop-loss policies, and all other benefit contracts. Responsibilities include all required filings and approvals with state regulators. Advises Regional Health Plans and management on the regulatory requirements for contracts and benefits and subject matter expertise and support on contracts & compliance to the entire organization on both a pre-sale and post implementation basis. Track, analyze and prepare summaries of state land federal laws, regulations; bulletins and other communications that impact (or similar) products. Manages, creates & maintains client relationships. In adherence with the Regulatory and Strategy work platform (or similar department work platforms), fosters comprehensive compliance management through a series of activities to ensure that insurance contracts; advertising and marketing materials; disclosure requirements and other ancillary insurance forms are in compliance with applicable regulations, statutes and KPIC’s contractual obligations. Series of Activities, under the leadership of more senior team members, include: Planning: identifying and may lead in the identification of regulatory and contractual accountabilities; may lead in the development of work and audit plans; participate and may lead regulatory-related work groups. Implementing: participating and may lead in the identification of regulatory and contractual requirements and conducting portions of related analyses, participating and may lead in the creation, development or revision of contract standards, templates, review and approval of forms ; policy and procedures ; monitor adherence to regulatory and contractual requirements and KPIC Policy&Procedures; prepares reports on compliance efforts and programs; Validating: reviewing regulatory and contractual requirements including participating and may lead in risk assessments and/or audits and participating and may lead in the investigation of instances of reported non compliance. Consulting: participate and may lead in providing subject matter expertise and support on contracts®ulatory compliance on both a pre-sale and post implementation phase. Issue Resolution: Works and may lead, collaboratively with regional health plans and management to proactively identify and resolve potential issues and problems. Participate, contribute and may lead to new and innovative product development including contract and plan document features. Responsible for the filing of Insurance contracts with the regulators. Researches and stays abreast of regulations, statutes and industry standards. Determines impacts of implementation of new regulations and statutes and required notifications, changes and training. Supports RFP process by assisting or may lead in the drafting of boilerplate responses as well as responding to ad hoc questions and requests. Participate in meetings with major brokers/consultants and prospective clients by providing subject matter expertise for self-funding contracts and plan materials.

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