Regulatory Relations

Compliance Program & Policy Development

Required Qualifications

Bachelor's degree required; JD, MBA, or relevant advanced degree a plus but not required.
Must be familiar with health insurance regulatory reporting requirements such as Mental Health Parity, Prompt Pay, Market Conduct, Gold Card, Balance Billing, and Network Adequacy.
8+ years of progressive experience in health insurance regulatory compliance, with direct experience at a fully insured commercial health carrier (HMO, PPO, or indemnity).
Demonstrated hands-on experience with state DOI rate/form filings and SERFF.
Experience supporting or leading multi-state licensing and market entry for an insurance carrier.
Strong working knowledge of state insurance codes, NAIC model laws/regulations, and federal requirements applicable to fully insured group and individual health coverage (ACA market reforms, HIPAA administrative simplification, COBRA/ERISA as applicable to fully insured plans).
Experience managing or responding to regulatory examinations and market conduct exams.
Excellent written and verbal communication skills, with the ability to translate complex regulatory requirements into practical business guidance for non-compliance audiences.
Highly organized, self-directed, and comfortable operating with significant ownership in a lean, fast-moving organization.
Excellent time management and organizational skills required to maintain the reporting calendar and state points of contact.

Preferred Qualifications

Experience specifically expanding a Texas-domiciled or Texas-licensed carrier into additional states.
Familiarity with Texas Department of Insurance requirements and relationships within the TDI.
Experience building a compliance function from an early stage (vs. only operating within an established, mature program).
Working knowledge of health plan network adequacy and provider contracting compliance requirements.
Professional certification such as CHC (Certified in Healthcare Compliance), CPCU, HIA, or AHIP fully insured/HMO designations.
Experience with fully insured group employer products specifically (as opposed to Medicare Advantage, Medicaid, or self-funded/ASO business), given Evry Health's current product mix.
Favorable consideration given to candidates who can also assist with Enterprise Risk Management (ERM) and ORSA-related risk management reporting.

What Success Looks Like in the First Year

New-state licensing and filing playbook established and successfully executed for at least one expansion state.
A documented, board-visible compliance program (policies, monitoring calendar, risk reporting cadence) is in place.
Strong, responsive working relationships established with the Texas DOI and any newly entered state DOIs.
Cross-functional teams (Product, Claims, Sales) have clear, practical guidance on regulatory requirements relevant to their work.

Telecommuting Requirements

This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
Must live in the United States within the CST or EST time zones.
Company business hours are weekdays 9-5 CST.
Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
Ability to keep all company sensitive documents secure.
Must live in a location that receives an existing high-speed internet connection/service.

Originally posted on Himalayas