Medicare & Marketplace Filings Analyst II

Job Summary:

The Medicare and Marketplace Filing Analyst II is responsible for preparing materials and assisting in the submission of the Company’s product filings of assigned products, including form development, and required regulatory filing/submissions to ensure timely and accurate product approvals.

Essential Functions:

• Prepare Qualified Health Plan (“QHP”) application materials, including but not limited to, Plan and Benefit templates, System for Electronic Rate and Form Filing (“SERFF”) and Health Insurance Oversight System (“HIOS”) submissions, and other submission documents required for QHP product approval
• Assists in the preparation of materials for the Company’s Medicare Advantage (“MA”) and Medicare-Medicaid Plan (“MMP”) annual application process, including but not limited to, PBP preparation, HPMS Plan Setups, Plan Crosswalks, Formulary Crosswalks, and other associated filings
• Prepare Service Area Expansion (“SAE”) and application materials, including the Notice of Intent to Apply (“NOIA”)
• Execute and update the department’s product filing strategic workplan.
• Maintain data benefit grid used to generate member documents such as the Evidence of Coverage (“EOC”), Summary of Benefits (“SB”), Annual Notice of Change (“ANOC”), and Schedule of Benefits (“Schedules”)
• Responsible for the generation and validation of member facing documents.
• Ensure assigned regulatory forms (i.e. EOC, SB, ANOC) and related benefit structures are accurately and effectively communicated
• Interact with State/Federal regulators to address questions and objections related to associated product filings; ensuring regulatory responses are accurate, compliance, written concisely, and timely. This includes, but is not limited to, facilitating responses between regulators and internal business owners, document revisions (i.e. EOC, Schedules), template revisions
• Maintain objection tracking log; facilitating business owner responses to regulatory inquiries.
• Review and analyze changes in insurance statutes and regulations impacting products and/or operational areas
• Responsible for executing the Company’s EOC review process
• Develop and oversee process to support and document utilization of CMS/State review and validation tools (i.e. Data Integrity Tool (“DIT”), Master Review Tool (“MRT”)), including documenting versions as changes are made
• Assist in the development of Product Forms & Filing related policies and procedures
• Perform any other duties, as may be requested

Education and Experience:

• Bachelor's degree in in business, health care, or related field; or equivalent years of relevant work experience
• Minimum of three (3) years of healthcare, insurance, or other highly regulated industry experience
• Minimum of three (2) years’ experience with SERFF, HPMS, and/or HIOS
• Understanding of database relationships and SharePoint knowledge preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Excel and other Microsoft Applications
• …