Regulatory And Compliance Specialist

You will contribute to the strength of our team approach to collaborative dental health.

Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this could be your new home!

Job Summary

The Regulatory and Compliance Specialist conducts research on Regulatory and Compliance and engages in regulatory advocacy by monitoring regulatory developments, supports strategies to improve the regulatory environment for the Company and coordinating the implementation of new state regulations and rules. Drafts and manages corporate policies and procedures, member contract language and filings, state exchange filings, provider contract filings and statutory reporting.

Essential Responsibilities

• Conducts research and provides concise information on regulatory requirements related to the Company’s lines of business.
• Actively engages in the development and publication of corporate policies and procedures in all areas of operations, sales, support, service, provider networks, etc.
• Coordinates the implementation of regulatory administrative rules in accordance with said rules and interpretations and advisories and provides direction to other departments and personnel regarding regulatory requirements and Compliance concerns.
• Serves as a project manager on key compliance initiatives and audits, providing reports to executive management on those items.
• Consults with internal business stakeholders and decision-makers to identify where existing or proposed administrative rules are unworkable and advises the organization on the development of strategies to frame for regulators language that would improve efficiencies for payors, leverage effectiveness and maximize utilization of each health care dollar.
• Serves as a content expert on state insurance and managed care requirements.
• Drafts and manages member contract language and filings.
• Develops regulatory tools, enables web-based services and responds to queries from others regarding regulatory compliance requirements.
• May assist and support management with the establishment of new product lines, rate determination and the development and/or filing of rates and related forms.
• Serves as a project consultant on priority regulatory, compliance and contractual issues.
• Coordinates the compilation of data, drafting materials and filing of mandated regulatory reports.
• Must have strong knowledge of state and federal laws governing health insurance and managed care (preferably in Washington and California) and laws affecting HCSC’s, HMO’s, disability carriers, as well as licensure requirements of contractual services.
• Understanding of legal principles involved in healthcare contract writing and interpretation, legislative and regulatory processes, policy and procedure development and legal principles in healthcare contract writing and interpretation.
• Strong knowledge all Microsoft Office applications.
• Broad knowledge of current trends in healthcare delivery systems and/or carriers.
• Performs any and all additional duties as requested and directed for this position.

Basic Qualifications

Experience

• Five or more (5+) years of work experience in insurance, healthcare or other similar legal fields.

Education

• BA Degree in Healthcare, Public Administration, Legal, Business or related field, or equivalent directly related progressive experience.

License, Certification, Registration

• N/A

Additional Requirements

• Ability to present, persuade and negotiate on regulatory matters.
• Ability to understand laws/regulations related to healthcare insurers, HMO’s, disability carriers and HCSC’s.
• Ability to communicate technical information to non-technical staff and communicate with medical professionals.
• Ability to develop policies and procedures, rules and other documentation in support of regulatory compliance
• Ability to demonstrate strong problem-solving and critical analysis skills.
• Addresses and resolves a variety of moderate to complex regulatory, legal, administrative rules and contract interpretation situations.
• Makes recommendations for improvements in processes, programs, and Regulatory and Compliance systems.
• Makes decisions based upon the appropriate application of best practices and protocols, and makes decisions where generally known procedures are often not in place.

Position Details

• Primary Location: Long Beach, California or Seattle, Washington
• Job Schedule: Full time
• Scheduled Weekly Hours: 40
• Shift: Monday – Friday; 8:00 am to 5:00 pm
• Travel: No

We look forward to having you on our team!