Under broad supervision, the Issuer Operations Analyst is responsible for certification and compliance of Quality Health Plans (QHP), including Stand-Alone Dental Plans (SADP), sold through the Exchange and the Small Business Health Options Program (SHOP).
Develops and implements policies, application processes, timelines, data corrections, and certifications.
Reviews data submissions, certification timeline bulletins and Notice of Benefit and Payment Parameters provided annually to identify changes to policies or processes.
Monitors the annual certification process for plans while conducting reviews of applications for compliance, adherence to federal and state plan certification standards.
Manages the annual auto re-enrollment process and forwards related health insurance carrier communications.
Confirms completion and accuracy of health insurance carrier and plan information within the enrollment system.
Performs periodic and targeted compliance reviews of health insurance carriers and plans ensuring compliance with market-wide standards and state-specific regulations.
Develops corrective action plans for non-compliance of health insurance carrier plans.
Maintains policies and operations of the Small Business Health Options Program, which provides small group health insurance coverage to eligible small businesses.
Process employer applications and provides eligibility determinations for coverage.
Provides data reports to the Internal Revenue Service (IRS), upon request.
Maintains records of enrollment reports in accordance with federal and state record retention policies.
Performs other duties as assigned.
Master's degree in a related field from an accredited college or university AND One year of experience required at the lower level Prgm Consultant 2 (GSP091) OR any other combination of education and professional experience that provides the requisite knowledge, skills and abilities to successfully perform the job.
Issuer Operations Analyst - State Based Exchange.
Under broad supervision, the Issuer Operations Analyst is responsible for certification and compliance of Quality Health Plans (QHP), including Stand-Alone Dental Plans (SADP), sold through the Exchange and the Small Business Health Options Program (SHOP). Monitors the annual certification process f...
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