Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
The Regulatory Analyst reviews and analyzes new and existing laws, regulations, and policies to determine their impact on commercial group and individual health and dental insurance plans, as well as self-funded plans. This role is responsible for managing policy documents, certificates of coverage, and other regulatory filings, and supports the organization’s compliance with regulatory requirements. The position facilitates adherence to state and federal regulations, internal processes, and filed documents. The Regulatory Analyst also drafts and reviews filed materials and internal documents to ensure alignment with state, federal, and organizational standards; prepares and submits required filings and reports; and serves as a liaison to internal departments and state and federal regulators. This is a FT WFH position. 

Pay Range
$65,682.16 - $82,107.97 annually (depending on experience)
*This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27772907&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. Bachelor’s degree or at least 3-5 years of experience in the health insurance industry required, including experience in contract drafting and interpretation or regulatory filings.
2. At least two years of experience in regulatory compliance, drafting contracts, contract interpretation and submission of required filings, or equivalent experience preferred.
3. Ability to work and think independently in researching, analyzing, interpreting, and disseminating information about complex insurance law and contracts. 
4. Ability to identify areas of compliance concern and develop recommendations for resolving compliance issues.
5. Ability to advise and direct all departments, including senior and executive positions, on the interpretation and implementation of regulatory requirements and contracts.
6. Strong audit skills to provide regulatory feedback on any subject matter from internal departments, including the ability to compare multiple documents and trouble shoot problems. 
7. Ability to organize and prioritize large workloads with competing demands in an efficient and timely manner.
8. Detail oriented with good organizational and problem-solving skills.
9. Strong and effective verbal and written communication skills.
10. Ability to maintain confidentiality and project a professional business image. 
11. Computer proficiency with Microsoft Office applications, Adobe Acrobat and internet research.
12. Ability to come into work on time and daily.

Primary Functions:

1. Prepare and file annual form filings with the State Insurance Divisions and CMS, including initial filings, amendments, and required responses to regulator requests or questions.
2. Research and interpret compliance requirements, including state and federal laws and regulations, and apply knowledge to company operational issues.
3. Review marketing materials, plan change notices, and other regulated communications for compliance.
4. Collaborate with other departments within the organization regarding compliance with contracts and state and federal regulations, including effective communication and education about state and federal regulations, implementation of benefit changes and process and procedure changes.
5. Evaluate sufficiency of, and interpret, contract benefits based on insurance law and internal standards and policies.
6. Assist with daily question workload regarding federal and state rules and regulations.
7. Review internal and external documents and content, including Request for Proposal responses, for compliance. 
8. Maintain a tracking system to retain historical information on benefit, contract, and regulatory interpretations to ensure accurate and consistent treatment.
9. Work with Contract Services in the production of contracts after State approval.
10. Audit internal departments for contract and regulatory compliance.
11. Perform other duties as assigned.

Working Conditions:

• Office environment with extensive close PC and keyboard use, constant sitting, and phone communication. Must be able to navigate multiple computer screens. Hybrid (in the Portland metro area) or work-from-home (outside the Portland metro area). A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business needs.
• Internally with all areas of the organization, including operational teams such as Sales, Product, Claims, Customer Service, Benefit Configuration, Underwriting & Actuarial, Contract Services, Membership Accounting, Pharmacy, Quality Programs, Healthcare Services, Informational Services, and Marketing. Externally with legal counsel, professional colleagues, state insurance regulators and federal regulatory agencies.

Together, we can be more. We can be better.
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Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.