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Centene Corporation · 1 hour ago

Contract Development Analyst III

New York, United States

Full-time, Contract

Hybrid

Mid Level

$70K/yr - $126K/yr

3+ years exp

Centene Corporation is transforming the health of communities across the nation, and they are seeking a Contract Development Analyst III to manage the creation and compliance of member contract documents. This role involves regulatory research, risk assessments, and collaboration with cross-functional teams to ensure quality and compliance of health insurance products in high-risk states.

Hospital & Health Care

Responsibilities

Responsible for performing detailed language analysis of the Ambetter/Commercial Evidence of Coverage (EOC) (member insurance contract) and other relevant member materials, to ensure quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Leads initiatives related to these activities

Drafts and creates alternative language to include in regulatory member materials, including the EOC, working closely with cross-functional teams, including health plan operational leadership, compliance and legal on approvals. Conducts research projects to provide guidance on legal, contractual and regulatory requirements for assigned states. Seeks to resolve member contract documentation issues which may negatively impact service to members. Leads initiatives related to these activities

Serves as a Subject Matter Expert within depth knowledge of health insurance products, procedures, and regulations. Analyzes pending legislation and regulations affecting Centene’s commercial product related to member materials and provides recommendations to the business regarding changes needed to member contractual documents. Performs risk assessment of member contractual materials related to passed and proposed legislation in high risk states

Assists in developing junior employees and maintains/updates training materials. Leads updates and maintenance of Policies and Procedures, Work Plans and any department training materials

Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market

Creates, drafts, and revises filing documentation, including but not limited Evidence of Coverage and regulatory checklists, Outlines of Coverage, Enrollment Applications, Notice of Coverage Changes, and Transparency Web Notices. Leads initiatives related to these activities

Facilitates EOC review meetings with impacted departments to discuss recommended EOC revisions and language and to formulate solutions/alternatives to proposed contract language for high risk states. Reviews include multiple phases of research, drafting and coordinating of internal approvals

Develops and presents communications with alternative viewpoints, including effectively and appropriately communicating during formal presentations and across different audiences. Builds persuasive arguments and secures cooperation of others. Determines the appropriate approach to problem solving, including anticipating barriers to solutions and developing alternative plans

Analyzes and creates appropriate responses to questions from regulators related to filing documentation. Works with cross-functional partners for the purpose of crafting appropriate responses and revising regulatory member materials. Leads initiatives related to these activities

Performs analysis of benchmark plan information (EHB, State Mandates and Benefit Limits) incorporating changes to contractual documents based on analysis

Leads reviews of member-facing documentation (reference guides, letters, etc.) drafted by other Departments for alignment of language and product intent. Responsible for redlining documents and maintaining version control

Understands multi-department processes and inter-relationships between commercial departments and operational needs, and maintain trust-based relationships and collaboration with other functional areas in order to lead projects and initiatives

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

Performs other duties as assigned

Complies with all policies and standards

Qualification

Regulatory documentation creationPolicy analysisCommercial health insuranceContract documentation draftingLegislation analysisRisk assessmentTraining developmentCommunication skillsTeam collaboration

Required

Bachelor's Degree in Business, Communications, Pre-Law or related field or equivalent experience required

3+ years regulatory experience including creation of regulatory documentation, policy analysis and product filings (CMS and/or State DOI) required

3+ years experience in commercial health insurance or a highly regulated industry required

3+ years experience drafting and auditing member contract documentation or related documents. Experience analyzing legislation and/or regulations and conveying findings