Note: The job is a remote job and is open to candidates in USA. Wellfleet delivers customer-centric accident and health insurance products and services. The Regulatory & Provider Network Filing Analyst prepares and submits student health insurance network filings and reports, ensuring regulatory submissions are timely, complete, and accurate. The role coordinates with internal and external stakeholders, interprets applicable laws and regulations, and oversees filings from inception through completion.
Responsibilities
- Serve as a subject matter expert (SME) in provider network regulations, accreditation requirements, network adequacy standards, and other new and existing laws pertaining to provider networks, guiding and advising across various business areas and activities, including internal and external stakeholders
- Implement and enforce best practices and policies, ensuring alignment with department and organizational goals
- Perform a detailed review of new legal and regulatory guidance to identify and implement any necessary changes
- Track regulatory submission deadlines, and proactively coordinate with external and internal stakeholders to prepare filings in advance of deadlines
- Oversee network filings and reports from inception to completion, ensuring that all submissions are accurate, well-written, and timely
- Regularly monitor open submission to ensure timely and accurate responses to any objections or requests for additional information
- Support the review and development of written responses for network submissions and responses to objections, as needed, and validate data to ensure accurate reporting
- Ensure all regulatory filings and reporting deadlines are met
- Implement and enforce best practices and assist with ad hoc projects to achieve departmental or organizational goals. Collaborate with internal and external stakeholders to perform network oversight, and develop and monitor corrective action plans, as needed
- Perform other duties as assigned
Skills
- Bachelor's degree in healthcare administration or related field, and 2+ years of health insurance experience, or a combination of education and experience
- Ability to work effectively with internal and external stakeholders
- Ability to interpret and apply state and federal laws and regulations
- Excellent written communication and interpersonal skills
- Strong organizational skills and the ability to manage competing priorities
- Proficiency with MS Office products including Outlook, Word and Excel
- Demonstrates a strong commitment to compliance and ethics
- Self-motivated with the ability to work independently, with very little supervisory direction
- Compliance and/or network experience preferred
- SERFF filing system experience preferred
- Familiarity with provider network regulations, accreditation requirements, and NCQA standards preferred
Benefits
- Life insurance
- Health insurance
- Dental insurance
- Vision insurance
- 401K retirement plan
- Short- and long-term disability coverage
- Flexible/dependent care spending account
- Tuition reimbursement
- Business casual dress
- Medical, vision and dental insurance options
- Life and accident insurance
- 401(k)
- Short-term and long-term disability insurance
- Hands-on training specific to your position
Company Overview