Regulatory Operations Business Analyst III

Business Area: Administrative & Claims Operations

Job Type: Full time

Position Purpose: 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) and assists in the development of 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.

Key Details : 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. 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.

• Oversees and prepares Qualified Health Plan templates and/or formal regulatory filing documents, seeking approval of our individual commercial marketplace health plans for Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF) filings for high-risk states.

• Audits QHP documents for high-risk states ensuring documents are compliant, accurate and align with product intent.

• Actively manages and collaborates with Sources of Truth (SOT) document owners for Qualified Health Plan (QHP) filing template and policy form development. Continuously supports SOT creation process and audits complex data inputs across SOT documents and/or as determined by DOI and CMS requirements.

• Attends, engages and represents their Regulatory Operations team in dynamic cross functional meetings to ensure currency of information related to regulatory and/or market landscape. Leads meetings as needed. Collaborates with cross functional teams to ensure QHP filing documents are accurate and align with product intent.

• Analyzes proposed and/or enacted federal and state legislation and/or regulatory orders. Communicates impacts and/or risks related to their Regulatory Operations team and Reg Ops Cross-departmental functions for advocacy and/or implementation needs.

• Leads implementation of passed legislation or new regulations impacting Qualified Health Plan (QHP) scope of work and/or related policy forms and filing templates.

• Takes ownership of, and coordinates team activities for the maintenance, implementation and continuous improvement of department policies, procedures, and work processes to ensure corporate standards are compliant.

• Assists with managing relationships with regulatory agencies (DOI and CMS).

• Leads onboarding of new employees and training of analysts on essential job duties; maintains and updates training materials.

• Coordinates and leads projects internal to the department acting as a subject matter expert for the department.

• May attend external and/or virtual conferences and seminars to evaluate industry trends.

• Performs other duties as assigned. Complies with all policies and standards.

Education/Experience: Bachelor's Degree 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 (Plans and Benefit, Pharmacy, Crosswalk, etc.) preferred. Experience auditing database or QHP filing documentation preferred. Knowledge of SERFF and/or HIOS systems preferred.

Pay Range: $70,100.00 - $126,200.00 per year

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. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act