Member Contract Development Analyst III

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time.

As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Position Purpose : Responsible for creation of member contract documents, including Evidence of Coverage (EOC) and related documents, for commercial products for high risk states.

Performs or assists with regulatory filings seeking approval of products for the commercial markets and performs research related to EOCs.

Conducts risk assessments, including impact to member contract documentation and downstream output, and monitors pending legislation and regulations affecting Centene's commercial product in high risk states in order to provide updates to relevant member contract documents.

• Serves as a Subject Matter Expert with in depth knowledge of health insurance products, procedures, and regulations. Develops and maintain assigned state member materials, including the Evidence of Coverage, and supporting documentation for commercial products.
• Assists in developing junior employees and maintains / updates training materials.
• Creates, drafts, and revises filing documentation (including Evidence of Coverage and regulatory checklists, Outlines of Coverage, Enrollment Applications, Notice of Coverage Changes, and Transparency Web Notices).
• Prepares member contract documents and other supporting documentation, and performs quality assurance audits on a member-facing documentation to ensure accuracy, consistency, and compliance.

Leads initiatives related to these activities.

• Develops and presents communications with alternative viewpoints, including effectively and appropriately communicating during formal presentations and across different audiences.
• Builds persuasive arguments and secures cooperation of others.
• Determines the appropriate approach to problem solving, including anticipating barriers to solutions and developing alternative plans.
• Communicates and assesses objections with cross-functional partners for the purpose of crafting appropriate responses for regulators.
• Performs analysis of benchmark plan information (EHB, State Mandates and Benefit Limits).
• Conducts reviews of member-facing documentation (reference guides, letters, etc.) drafted by other Departments for alignment of language and product intent.

Responsible for redlining documents and maintaining version control.

• Performs risk assessments, including impact to member contract documentation and downstream output, of pending legislation and regulations and implements changes to documents affecting Centene’s commercial product in high risk states.
• Maintains and update Policies and Procedures, Work Plans and any department training materials.
• Conducts research projects to review guidance on legal, contractual and regulatory requirements for assigned states. Seeks to resolve member contract documentation issues which may negatively impact service to members.
• Understands multi-department processes and inter-relationships between commercial departments and operational needs, and maintain trust-based relationships and collaboration with other functional areas in order to lead projects and initiatives.
• Facilitates meetings and and review of contract language with internal stakeholders, including phases of research, drafting and coordinating of internal approvals, and appropriately escalates matters to management.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education / Experience :

• Bachelor's Degree in Business, Communications, Pre-Law or related field or equivalent experience required
• Master's Degree in a related field or Jurisprudence (JD) preferred
• 3+ years regulatory experience including creation of regulatory documentation, policy analysis and product filings (CMS and / or State DOI) required
• 3+ years experience in commercial health insurance or a highly regulated industry required
• 3+ years experience drafting and auditing member contract documentation or related documents. Experience analyzing legislation and / or regulations and conveying findings.

Understanding policy issues impacting the healthcare sector preferred

Pay Range : $67,400.00 - $121,300.00 per year

Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act