Senior Insurance Product Compliance Professional
H
HumanaHealthcare Insurance
United StatesFull-TimeSenior
Salary$78,400 - $107,800 per year
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Job Details
- Experience
- Minimum 5 years of healthcare / insurance industry experience
- Required Skills
- HIPAA
Requirements
- Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function.
- Minimum 5 years of healthcare or insurance industry experience.
- Deep knowledge of laws and regulations governing the healthcare/insurance industry (e.g., State Departments of Insurance, CMS).
- Ability to research and analyze state laws and regulations.
- Understanding of insurance products and policy language.
- Proficiency in Adobe Acrobat and Microsoft 365 (Word, Excel, Teams, SharePoint).
- Excellent oral and written communication skills.
- Demonstrated attention to detail, accuracy, and problem-solving ability.
- Self-motivated and task-oriented with the ability to manage multiple priorities.
- Requirement for a dedicated workspace with high-speed internet (min 25 Mbps download/10 Mbps upload) to protect PHI/HIPAA information.
Responsibilities
- Manage the annual On-Exchange (ACA) form, template, and supporting documentation submission process for Qualified Dental Plan certification.
- Monitor and analyze state/federal regulatory requirements to assess contract language impacts.
- Negotiate with state and federal regulatory agencies to obtain approval of insurance policy and certificate forms.
- Draft generic and state-specific contract language for Individual Specialty policies while ensuring readability standards are met.
- Research and develop responses to regulatory objections, exams, and inquiries.
- Serve as a Subject Matter Expert for Specialty lines of business.
- Conduct quality reviews of generic and state-specific policy forms.
- Provide consultative guidance and training to other associates within the team.
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