Regulatory Operations Business Analyst IV

Position Purpose: Completes Qualified Health Plans (QHP) federal and/or state required application templates and documents for low, medium and high risk states, including policy forms for individual commercial marketplace products. Reviews and provides interpretation of application instructions from regulatory agencies 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 high-risk states. Develops and leads special projects and large initiatives, representing the department as a subject matter expert in cross-functional forums. Assume a non-disciplinary supervisory role within Regulatory Operations for the purpose of mentoring junior staff members in their professional growth and support of Centene business goals. Key Details: 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. Prepares and oversees completion of 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, ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Mentors and oversees completion of work by junior team members. Audits QHP documents for low-medium-high risk states ensuring quality control, compliance with State and Federal regulations as well as organizational standards, and compliance with internal Company operations, products and financial arrangements. Coordinates and oversees audits for the department. Develops and implements continuous improvement activities targeting build, audit and quality initiative strategies. Leads management of Sources of Truth (SOT) documents 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. SOT is relied on by numerous cross functional teams for benefit and cost share information which is utilized in public and member facing documents. 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 cross functional teams in data review to ensure Qualified Health Plan (QHP) filing documents are accurate and align with product intent. Independently analyzes proposed and/or enacted federal and state legislation and/or regulatory orders to determine…