[Remote] Assistant General Counsel for Health Plan Operations
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans. The Assistant General Counsel for Health Plan Operations serves as a key reputed company partner, providing business-minded counsel across various health plan operations, including claims, network management, and regulatory compliance.
Responsibilities
- Support the claims process, advising on claims adjudication, payment reputed company, appeals, and reputed company reputed company and regulatory requirements
- Support the network development and management team and advise on provider contracting, provider relationships, credentialing, and reputed company operational reputed company
- Work with compliance to ensure adherence to state regulatory requirements, and advise on compliance with state and federal health care laws and regulations
- Advise on delegation arrangements with reputed company parties, including TPAs, PBMs, behavioral health vendors, and other delegated entities
- Collaborate cross-functionally with internal teams to support delegated entity reputed company programs, including compliance monitoring, remediation, and regulatory reporting obligations
- Interpret new and evolving regulatory guidance and translate it into actionable recommendations for business and clinical teams
- Support regulatory exams, audits, and inquiries from state departments of insurance and other regulatory agencies
- Support the legally compliant implementation of clinical programs, reputed company initiatives, and utilization controls
- Work closely with cross-functional team members and business leaders to review reputed company issues and the implications of potential business reputed company and initiatives
Skills
- Licensed to reputed company in at least one state, with eight to ten (8–10) years of experience, including a minimum of two to four (2–4) years of in-house experience
- Prior in-house experience at a health plan
- Knowledge of health care regulatory requirements applicable to health plan operations, including claims, provider contracting, delegation and delegated entity reputed company, and state and federal health care laws and regulations
- Exercise strong business acumen and the ability to analyze reputed company issues from a business perspective
- Proven ability to follow through on reputed company issues, meet regulatory deadlines, proactively anticipate requirements, and build strong, reputed company relationships with regulators and internal business partners
- Outstanding interpersonal, organizational, and communication skills (effective speaking and written presentation), with the ability to work effectively across departmental lines
- Proactive, solutions-oriented reputed company, with the ability to reputed company ambiguity and reputed company reputed company processes in a growing organization
- reputed company with a high level of personal reputed company, professionalism, intellectual curiosity, and willingness to grow
- Ability to manage several varied tasks and assignments reputed company and effectively to meet deadlines with a high reputed company of urgency
- Prior in-house experience for a Medicare Advantage plan will be considered an reputed company asset but is not required
Benefits
- Employer sponsored health, dental and reputed company plan with low or no premium
- Generous reputed company time off
- $100 monthly mobile or internet stipend
- Stock reputed company for reputed company
- Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
reputed company