CareFirst Careers

Lead Regulatory Policy Analyst (Mandates)

Resp & Qualifications

The Lead Regulatory Policy Analyst reports to a Manager, or Director of Mandates Implementation and Compliance and provides analysis and recommendations on external mandates for strategic decision making both internally and externally, and for ensuring support of the company’s business objectives and requirements. The incumbent has key responsibility for ensuring the division is positioned to communicate the specific impacts from mandates to the rest of the organization.. The incumbent must have an excellent working knowledge of the core business functions at CareFirst .  The Lead Regulatory Policy Analyst  will provide subject matter expertise on the most complex implementations of external mandates and may coordinate a team of Sr. Regulatory Policy Analysts in reviewing large complex regulations.   Interface with industry contacts, vendors, government agencies, associations, and other sources of information.  Attend industry meetings to monitor the discussion of other payors and industry professionals.   The Lead position may be required to document and present regulatory analysis to Senior Management.  The Lead must be capable of providing recommendations in support of strategic decision-making.

Critical skill for the position is the ability to read statutues, bills and regulations and understand and communicate their impact on the operations and business practices at CareFirst - knowledge of health insurance operations is required.  Successful candidates must posess the ability to communicate in a clear, concise manner both verbally and in written communications.  Looking for a self-starter with the ability to think creatively and strategically.   Good "people skills" are a must as the position will work across the organization at all levels.

There are two positions.  One position will be specifically focused on our diversified benefits portfolio and extraterritorial requirements; knowledge about group life insurance, short term disability and other non-health insurance is preferred.  Extraterritorial requirements are fees or other requirements imposed on CareFirst or CareFirst members by states outside the CareFirst service area.


PRINCIPAL ACCOUNTABILITIES:
Under the general supervision, the incumbent’s accountabilities may include, but are not limited to, the following:

1. Support internal and external policy decisions by providing sr. management and project teams with extensive analysis and recommendations on the operational impacts to CareFirst from external mandates, acting as a consultant at all levels to provide guidance. Identifies and analyzes all emerging issues as well as proposed laws and regulations affecting the health insurance industry as well as distilling complex subject matters into logical communications. Represents the mandates division at Ops Council and other meetings with senior management.

2.  Leads the development efforts for functional models to demonstrate operational impact assessments of mandates and other scholarly information. These functional models demonstrate CareFirst interaction with new and existing regulatory bodies as well as new and existing CareFirst business partners and members

3.  Research and analyze information on external mandates from articles, white papers and regulations and create assessments of impacts on the CareFirst business model. Participate in external work groups created by the Blue Cross and Blue Shield Association (BCBSA), and others as needed. Oversee the creation and maintenance of compendiums of industry and CareFirst data to provide a well-organized set of reference materials on external mandates.  Explore the availability of new information to enhance these materials. Reviews interpretation and assessment documentation prior to legal review.  Provide consultative services to project teams as subject matter expert on assigned mandates.  Responsible to ensure project meets compliance requirements and that all required compliance reviews are performed during the project lifecycle.

4. Conduct timely policy and regulatory briefings on the operational impacts of external mandates for senior management. Monitor critical health care reform issues and prepare memoranda, background papers and presentations for internal and external distribution.  Champions mandate compliance and mandate awareness across the company

5.  Package operational impact assessments of external mandates on the CareFirst business model.  Customize content according to the level of management to facilitate decision making and action.

6. Lead team of Regulatory Policy Analysts or Project Managers in the decomposition and documentation of large and/or complex regulations.


QUALIFICATION REQUIREMENTS:
Required Experience:
BA or BS degree, preferably in Political Science, Health Policy, Mathematics, Finance or related field or equivalent experience. In addition, must have 6 years experience working in a legislative or healthcare environment focused on the regulatory process including interpretation of proposed and final regulations, and communication with varying levels of leadership both internally and externally. 


Skills/Abilities:

  • Extensive knowledge of state legislative and regulatory processes, public policy analysis.
  • Extensive knowledge of healthcare payor industry and operational impacts of regulatory guidance
  • Must understand insurance products and regulatory environment.
  • Proven analytical and problem solving skills to evaluate business processes and recommend effective solutions.
  • Superior analytical skills and understanding of where to find information germane to mandates
  • Excellent written and oral communications skills
  • Ability to work with all levels within the organization and to build highly cooperative and productive relationships
  • Ability to reach outside the organization to gather information
  • Effective communication skills with the ability to tailor information for specific audiences
  • Ability to lead cross functional teams of varying sizes
  • Ability to present highly complex ideas to create a clear picture of impacts to the organization
  • Ability to act on behalf of management in a manner that is consistent with divisional vision
  • Ability to act in consultative manner to Senior Management  to determine strategic direction related to the operationalization of  mandates


Preferred:

  • MBA

Department

Department: Mandates Implementation - MD

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 12/8/2018

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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