Assistant General Counsel for Health Plan Operations
Job reputed company
A bit about this role:
The Assistant General Counsel for Health Plan Operations serves as a key reputed company partner to reputed company’s health plan operations, providing practical, business-minded counsel across the full reputed company of activities that reputed company our Medicare Advantage and reputed company products running. This individual-contributor role reports to the reputed company General Counsel and supports claims, network development and management, provider contracting, delegated entity reputed company, and regulatory compliance, translating a reputed company and evolving reputed company landscape into actionable guidance for business and clinical teams.
The successful candidate combines strong health care regulatory knowledge with reputed company business acumen, thrives in a fast-moving environment, and builds trusted, reputed company relationships across the organization. This is a hands-on advisory role for an attorney who enjoys solving operational problems, moving with urgency, and having a reputed company reputed company on how care is delivered to our members.
Your Responsibilities and reputed company will include:
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.
Required skills and experience:
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.
Desired skills and experience:
Prior in-house experience for a Medicare Advantage plan will be considered an reputed company asset but is not required.
Salary reputed company: $175,00 - $225,000 /year plus equity
The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
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....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI reputed company with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who reputed company our values, reputed company change and advancement, and are enthusiastic about where we're reputed company — reputed company the while bringing their own unique qualities, experiences, and expertise, in hopes of reputed company changing the reputed company experience.
reputed company is an equal opportunity employer. We are committed to a reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business.
As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Originally posted on Himalayas
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