Senior Regulatory Consultant

Develop (and/or revise), file and support all certificates of coverage, self-funded benefit guides, riders, schedule page, forms, and templates in compliance with federal and state regulatory requirements. Obtain internal approval of filed documents through coordinating with other HAP departments. Coordinate interaction with other departments to assure appropriate individuals are involved and kept updated during the course ofdeveloping and filing requisite documents in the product development process.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Manage the development and drafting of state and federal forms commensurate with business objectives and in compliance with product regulatory requirements.
• Manage the submission process for state and federal form filings commensurate with business objectives and in compliance with product regulatory requirements.
• Serve as point of contact and manage relationship with regulatory reviewers. Work with peers and other business departments to obtain responses when a regulatory reviewer objects to certificates, riders and forms that have been filed. Submit objection responses to the states and interact with reviewers at the state or federal insurance departments to discuss outstanding filings, objections, etc., and negotiate timely approval of company products.
• Work with internal departments to develop a streamlined process for updating riders, certificate of coverage, schedule pages, self-funded benefit guides, and other legal forms for filing. Create and maintain centralized repository for filings.
• Develop and maintain annual filing schedule for all common certificates of coverage, including Medicare Advantage and Medicaid as appropriate.
• Develop processes for development of templates for certificates of coverage, self-funded benefit guides, riders, and forms as needed.
• Serve as product filing regulatory subject matter expert to leadership of the corporation.
• Serve as the liaison between HAP departments, committees, the Michigan Department of Insurance and Financial Services (DIFS) or third parties as requested.
• Investigate and respond to requests for information from regulatory agencies on behalf of the corporation. Apply problem-solving techniques to assist business unit personnel with responding to DIFS regulatory compliance issues.
• Conduct research of pertinent legal statutes and/or regulations for product strategic initiatives. Review, analyze and summarize key findings of documents, proposals,developments as requested.
• Responsible for due diligence matters by managing receipt and review of relevant information, liaison with third parties, conducting due diligence analysis, working with integration team to secure and disseminate information, coordinate with internal resources to develop follow-up due diligence requests/clarifications and transmit same to target; secure follow-up detail and review or share results with corporate leadership as necessary and appropriate.
• Provide guidance and training as needed and provide training to other department/company individuals as needed.
• Representative for HAP strategic implementation committees, such as the Custom Product Review, Benefit Implementation Team, Medical Reimbursement Policy Committee, etc.
• Perform other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s Degree. Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years of experience in directly comparable experience in a health plan or insurance company.
• Minimum of seven (7) years in managed care or insurance industry in professional role with working knowledge of benefits, benefit design, compliance, health plan operations, or health care policy.
• Experience or willingness to learn NAIC’s System for Electronic Rate and Form Filing (SERFF). Capability to stay current with SERFF and train other department members on use of SERFF and its evolution.
• Experience using Microsoft Word, Excel, and Access.
• Detailed knowledge of broad range of Health Care delivery models (HMO, PPO,Medicare & Medicaid, and self-funded products) and understanding of the healthcare industry including providers and payers.
• Strong analytic and research background.
• Experience in managing multidisciplinary projects/initiatives.
• Ability to collaborate and interact with executive/senior leadership.

CERTIFICATIONS/LICENSURES REQUIRED:

• SERFF certification or willingness to obtain the certification within 6 months of hire.

Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

major academic medical centers, receiving between $90-$100 million in annual research funding and

remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

education and training, the health system has trained nearly 40% of physicians currently practicing

in the state and also provides education and training for other health professionals including nurses,

pharmacists, radiology and respiratory technicians. visit HenryFord.com.

Whether it's offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it's all about choice. Henry

Ford Health System has a new approach for its employee benefits program - My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning - options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.