Responsible for development and drafting of KPIC (or similar) contracts and providing regulatory compliance consulting for the organization's fully insured line of business, ensuring customer satisfaction and compliance with contractual obligations, as well as alignment with business strategies and goals. This includes the development and administration of employer contracts, certificates of insurance, schedules of coverage, stop-loss policies, and all other benefit contracts. Responsibilities include all required filings and approvals with state regulators. Advises Regional Health Plans and KPIC management on the regulatory requirements for KPIC contracts and benefits and subject matter expertise and support on contracts & compliance to the entire KP organization on both a pre-sale and post implementation basis. Track, analyze and prepare summaries of state land federal laws, regulations; bulletins and other communications that impact KPIC (or similar) products.
• Manages, creates & maintains client relationships.
• In adherence with the KPIC Regulatory and Strategy work platform (or similar department work platforms), fosters comprehensive compliance management through a series of activities to ensure that insurance contracts; advertising and marketing materials; disclosure requirements and other ancillary insurance forms are in compliance with applicable regulations, statutes and KPIC's contractual obligations.
• Series of Activities, under the leadership of more senior team members, include: Planning - leading in the identification of regulatory and contractual accountabilities, development of work and audit plans; establishing and/or leading regulatory-related work groups and managing external agency relations. Implementing - leading in the identification of regulatory and contractual requirements and directing related analyses, creation and revision of contract standards, templates, policy and procedures on review and approval of forms; KPIC's policy and procedures; leading the monitoring adherence to regulatory and contractual requirements and KPIC Policy & Procedures; and directing reporting on compliance efforts and programs; Validating - reviewing regulatory and contractual requirements including leading in risk assessments and/or audits, and leading in the investigation of instances of reported non compliance. Consulting - leading and directing in providing subject matter expertise and support on contracts and regulatory compliance on both a presale and post implementation phase. Issue Resolution - Leads or directs in working collaboratively with regional health plans and KPIC management to proactively identify and resolve potential issues and problems. Continuous Product & Service Improvements - lead and direct in the development or modification of new and innovative product development including contract and plan document features.
• Leading in the development and drafting of KPIC contracts; Advance.
• Researches and stays abreast of regulations, statutes and industry standards. Determines impacts of implementation of new regulations and statutes and required notifications, changes and training.
• Supports RFP process by leading or directing in the development, creation or modification of boilerplate responses as well as responding to ad hoc questions and requests.
• Participate in meetings with major brokers/consultants and prospective clients by providing deep subject matter expertise for self-funding contracts and plan materials.
• Minimum eight (8) years of health care regulatory compliance and filing, contract writing, health care operations; legal research; or insurance/health plan governance experience.
• Bachelor's or legal degree, OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.
Knowledge, Skills, & Abilities:
• Expert knowledge of health care regulatory policies practices and systems.
• Complete understanding of regulatory compliance principles, theories and concepts.
• Contributes to the development of regulatory compliance principles, theories and concepts.
• Broad to advanced knowledge of health care industry practices and standards, analysis and reports.
• Project Management skills.
• Excellent writing skills in the following areas: health insurance contracts including group contracts, certificates of insurance and schedules of coverage.
• Advanced knowledge of insurance products.
• Must be able to work in a Labor/Management Partnership environment.
• Experience with System for Electronic Rate and Form Filing (SERFF) highly preferred.
• Experience dealing with State Insurance Department Regulators preferred.
• Professional Insurance designations: FLMI (Fellow Life Management Institute) and/or HIA (Health Insurance Associate) and/or AIRC (Associate Insurance Regulatory Compliance) preferred.
• Intermediate to advanced skills in Microsoft Word, Excel, and Adobe Acrobat preferred.