About the position The Healthcare Review/Audit Policy Member is responsible for monitoring federal/state policy changes and court rulings relevant to the Exchanges (e.g., changes impacting the Advanced Premium Tax Credit (APTC)/Qualified Health Plan (QHP) eligibility, and Special Enrollment Periods (SEPs), and through reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation; Assesses the impact of those changes on Exchange Improper Payment Measurement (EIPM) methodology, including review unit logic, scripts, and review tools, and determines where updates are required; Develops policy update deliverables and coordinates with technical, review, and data teams to accurately reflect changes.

Responsibilities

• Monitoring federal/state policy changes and court rulings relevant to the Exchanges
• Reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation
• Assessing the impact of changes on Exchange Improper Payment Measurement (EIPM) methodology
• Determining where updates are required for review unit logic, scripts, and review tools
• Developing policy update deliverables
• Coordinating with technical, review, and data teams to accurately reflect changes

Requirements

• Bachelor’s degree
• 3-5+ years of relevant experience
• Experience working in or knowledge of the Affordable Care Act, specifically State-Based Exchanges, Federally-Facilitated Exchanges, and health insurance markets and exchanges
• Ability to oversee multiple concurrent workstreams
• Excellent communication skills (verbal and written)
• Strong stakeholder management skills and experience

Nice-to-haves

• Experience with regulatory analysis
• Ability to navigate ambiguity and provide clear guidance, direction, and structure to the team
• Flexibility and agility to respond to changing requirements in a dynamic environment
• Skills to develop training on regulatory updates and train team members on the impact of the changes
• Proficiency working with compliance team members and developers to confirm that regulatory changes are properly reflected in testing methodology and automation scripts

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend