This position is an in-house counsel position that will assist in advancing the important business objectives, interests and image of the company through various activities, with a focus on providing legal support to the company's commercial line of business. The ideal candidate will have Commercial Insurance, and/or Medicare managed care subject matter expertise and an ability to develop an understanding of the business and operational goals of assigned internal clients, proactively advise business partners on a wide variety of matters, and work collaboratively with other attorneys on matters related to legal and regulatory compliance.
The position will be primarily responsible for:
- Advising the business on a broad range of legal, regulatory, and compliance issues, to mitigate risks associated with the company's Exchange product line.
- Identifying business and legal risks and working with the business to provide solutions that balance legal issues and business objectives.
- Researching local jurisdictional requirements for licensure and other market entry regulatory requirements, and providing guidance and assistance in the timely completion of application materials
- Policy drafting experience and in-depth knowledge of statutes/regulations including declarations page and endorsement requirements/drafting, cancellation and non-renewal statutes/regulations,
- Knowledge of marketing requirements and review of same
- Knowledge and review/drafting of internal policies, training materials, notifications and procedures, and external-facing materials such as policy/coverage forms, to ensure compliance with related regulatory requirements
- Knowledge and experience in drafting and reviewing agent/company agreements and agent licensing including agent terminations, disputes and broker of record letters
- Coordinating Market Conduct Examinations
- Handling policy holder disputes/claims
- Dealing with state insurance departments/regulators
- Drafting and negotiating contract vendor/supplier contracts that support the company's Exchange product.
- Experience in internal accounts receivable/payable requirements including handling of premium
- Keeping up to date and advising on the potential impact of new and proposed healthcare laws and regulations to ensure continued compliance.
- Operating with a high degree of integrity, in alignment with company mission and culture.
- Performing other special assignments, strategic projects, or duties as needed.
Education/Experience:
- JD required
- License to practice law in at least one state.
- Knowledge and experience in Health Care and laws and regulations pertaining to commercial insurance products, Provider contracts, business transactions, labor/human relations and/or vendor contracts.
- Experience in counselling in a corporation/law firm specializing in accident and health insurance. Exchange product experience helpful
- 10 years of experience after receiving law degree.
Other Skills:
- Demonstrated analytical skills and strong legal project management and facilitation skills.
- Strong ability to provide risk assessment/risk mitigation support and strong negotiation skills.
- Ability to work both independently and collaboratively, provide leadership, influence organization behavior and create alignment across organizational lines.
- Excellent written and verbal communication skills, and the personal presence, credibility, and the professional demeanor necessary to interact with company management, regulatory bodies, and business units with persuasiveness and confidence.
- Collaborative team player with an ability to effectively manage competing priorities.
- Ready, willing and able to assist with new needs and comfortable with uncertainty and ambiguity.
- Excellent judgment and the ability to prioritize and make difficult decisions quickly.