Medicare and Marketplace Filing Analyst III

Job Summary:

The Medicare and Marketplace Filing Analyst III leads the overall management of the Company's product filing lifecycle of assign products, including form development and required regulatory filing/submissions to ensure timely and accurate product approvals.

Essential Functions:

• Executes and leads the end-to-end processes and related tasks in order to obtain product approvals for the Company's Medicare Advantage, Medicare-Medicaid Plan ("MMP") and Health Insurance Marketplace ("Marketplace") product offerings. This includes, but is not limited to, annual CMS and State applications, Qualified Health Plan ("QHP") Application, and associated filings
• Develop and coordinate the product filing strategic workplan, including assigning action plans to other analysts
• Responsible for executing the Marketplace QHP Application process, including System for Electronic Rate & Form Filing ("SERFF") (form/rate/binder) and HIOS submissions, including creating QHP templates for associated filings
• Responsible for overall Medicare Advantage bid completion in Health Plan Management System ("HPMS") and submission process, including but not limited to, PBP preparation/submission, and other associated filings
• Execute and complete the overall Service Area Expansion and application.
• Overall ownership and responsibility for associated member materials for all products, including but not limited to the Evidence of Coverage ("EOC"), Summary of Benefits ("SB"), Annual Notice of Change ("ANOC"), and Schedule of Benefits ("Schedules")
• Ensure assigned regulatory forms (i.e. EOC, SB, ANOC) are accurately mapped in the Company's document generation system to ensure benefit structure is 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, PBP interpretations
• Provide technical guidance to translate PBP and QHP template decisions to business operational tactics
• Review and analyze changes in insurance statutes and regulations impacting products and/or operational areas
• Responsible for executing the Company's EOC review process
• Perform any other duties, as may be requested

Education and Experience:

• Bachelor's degree 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 (3) years' experience with SERFF, HPMS, and/or HIOS required
• Understanding of database relationships and SharePoint knowledge preferred

Competencies, Knowledge and Skills:

• Advanced proficiency level with Microsoft Excel
• In-depth knowledge of SERFF, HIOS, HPMS, and other government systems
• Ability to work cross-departmentally to accomplish departmental and company goals
• In-depth understanding of health insurance and product filings

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$79,800.00 - $127,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.