Job Summary:
The Medicare and Marketplace Filing Analyst II is accountable for supporting the overall management of assigned Product forms development, required regulatory filings/submission, and reporting.
Essential Functions:
- Participate in Product Forms & Filing strategic planning, implementation and execution of assigned action plans, as requested
- Execute and support the end-to-end processes, related tasks, for the annual CMS and state application, Health Insurance Marketplace Product certification and required Form, Rate, Qualified Health Plan (QHP) binder, and marketing material, submission/filing work to secure the annual QHP certification, as assigned
- Execute the activities required to communicate the annual Product regulatory form updates/changes to identified stakeholders, including Product, Markets, and impacted functional/operational teams, as assigned
- Execute assigned Product Forms & Filing tasks, including action plans/work schedules to support required Product form development, related tasks, filing and associated implementation activities
- Participate in the support, development, and execution of the Product Forms & Filing teams Key Performance Indicators (KPIs)
- Populate Health Insurance Marketplace Qualified Health Plan (QHP) filing templates, including Plan and Benefits template , as assigned
- Complete Medicare CMS Plan Benefit Package software and submit all Bid Submission documentation in CMS Health Plan Management System (HPMS) system, as assigned
- Ensure assigned regulatory forms (i.e. Evidence of Coverage (EOC), Schedule of Benefits and Summary of Benefits, etc.) are accurate, retained in the assigned Product Forms & Filing shared drive/SharePoint location, and distributed timely to identified stakeholders
- Complete Schedule of Benefits and Summary of Benefits templates, ensuring benefit structure is accurately and effectively communicated
- Utilize applicable CMS/state review and validation tools (i.e. Data Integrity Tool (DIT) for QHP filing templates) and Product Forms & Filing checklists
- Participate in Healthcare.gov Plan Preview and user acceptance testing to validate flow of Product benefit structure(s)
- Execute to published Product Forms & Filing related Policy & Procedures
- Serve as Product Forms & Filing Analyst for assigned Products, including interacting and communicating with state/federal regulators to address questions and objections related to Product filings
- Ensure all regulatory responses to Product bid and/or filing questions and objections, are accurate, compliant, written succinctly, and meet established deadlines.
- Execute assigned test plans and scenarios to support Product, benefit and reimbursement integrity
- Work with Actuarial, Marketing and applicable business owners to validate benefit design, as assigned
- Develop and maintain effective relationships with key internal and external stakeholders to support assigned Product filings/submissions.
- Perform any other duties, as may be requested
Education and Experience:
- Bachelor's degree in Business, Health Care, a related field, or equivalent years of relevant work experience, is required
- Minimum of three (3) years of healthcare, insurance, managed care, or other highly regulated industry experience is required
- Minimum of two (2) years System for Electronic Rate & Form Filing (SERFF) experience required
- Health Insurance Oversight System (HIOS) and/or Health Plan Management System (HPMS) experience preferred
Competencies, Knowledge and Skills:
- Intermediate to advanced proficiency level with Microsoft Word and Excel
- Familiar with Adobe Writer
- Cross-functional team skills
- Ability to work independently and within a team environment
- Time management skills
- Decision making/problem solving skills
- High detail orientation skills
- Proven strong organizational and analytical skills
- Ability to work in a fast-paced environment, adjust as instructed to support key Product Forms & Filing deliverables
- Effective and timely communication skills (both written and verbal)
- Effective active listening and critical thinking skills
- Display a customer service, member-focused orientation
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$69,400.00 - $111,000.00
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 (hourly/salary):
Salary
Organization Level Competencies
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.
