Regulatory Operations Analyst III

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.   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, F-1, J-1, OPT, or CPT.

Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics.  Performs state or federal policy research, regulatory reporting, and regulatory change monitoring with a goal of supporting compliance, regulatory readiness, and formal regulatory approval of commercial and Marketplace products. Identifies, analyzes and interprets proposed or enacted legislation related to Centene's commercial product at the federal and state level and communicates findings to impacted departments.  Independently performs risk assessments, including impact to business applications, claims operations, payment integrity processes, and downstream output.  Maintains databases, reports, exhibits, and other reference materials related to legislative, regulatory, compliance, audit, and inquiry activities.  Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level.  Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level.  Provides guidance to business partners regarding emerging regulations, regulatory inquiries, audit activity, fraud, waste and abuse (FWA) oversight, and payment integrity matters. Coordinates regulatory inquiries, reporting requirements, exhibits, audits, and requests from state and federal agencies, maintaining accurate and timely responses in partnership with operational stakeholders. Partners with Compliance, Special Investigations Unit (SIU), Payment Integrity, Claims Operations, Finance, and other cross-functional teams to identify regulatory risks, support investigations, and analyze operational trends. Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues.  Ability to determine appropriate approach for solving regulatory problems.  Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives.  Attends cross-departmental meetings as department representative, provides guidance to the business related to commercial regulatory requirements and appropriately escalates matters to management. Develops solutions to address potential legal, contractual and regulatory issues while working closely with Legal, Compliance, Payment Integrity, and other operational stakeholders.  Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs.  Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.  Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings.

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