Gateway Health Plan
Job Description :
This job maintains the organization’s ongoing relationships with regulatory commissions/authorities. Implement policies and programs to ensure the organization is in compliance and meeting reporting requirements. Coordinates and conducts the assessment of internal controls to ensure compliance as required by regulatory commissions/authorities. Develops programs and processes to manage complaint cases brought to regulatory authorities and develops process improvements to avoid future complaints. Advances the organization’s position with internal and external parties.
- Submit regulatory filings to obtain required approvals to market insurance products, offer networks, perform administrative services, and maintain compliance with emerging law and regulation.
- Draft policy forms, researches mandates, composes or gathers other content, and completes reports to meet state mandates, regulator objections and inquiries; and maintains relationships with state reviewers.
- Perform procedures for: control and dissemination of regulated documents; tracking/storage of filings, approved forms, licensure information and reports; and communication of related mandates.
- Provide compliance support to other business areas including advertising review, inquiry response, project participation, research, policy form interpretation, problem resolution and maintenance of information sources on related mandates.
- Support or coordinate state regulatory examinations, surveys and data calls.
- Other duties as assigned or requested.
- 6 years of related and progressive experience in lieu of Bachelor’s degree
- Masters Degree or Juris Doctorate
- 3 years of relevant, progressive experience in the area of specialization. Grandfathered experience requirements effective August 2016.
LICENSES or CERTIFICATIONS
- Strong written and oral communication skills
- Strong relationship building skills
- Client focused with strong business acumen
- Self-starter with the ability to work under pressure independently and as part of a team
- Ability to think strategically and act proactively to create strong trust and confidence with business units
- Strong innovative problem-solving capabilities
Language (Other than English):
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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