Position Summary:
Our customer is seeking a detail-oriented compliance specialist to support the certification and compliance of Quality Health Plans (QHPs) and Stand-Alone Dental Plans (SADPs) sold through state-managed ACA insurance carriers. Reporting to the Issuer Operations Manager, this role involves policy implementation, compliance monitoring, and effective communication with health insurance carriers.
Key Responsibilities:
- Develop and enforce policies for QHP/SADP applications, timelines, and data corrections.
- Review annual regulatory updates (CCIIO guidelines, Payment Parameters) and revise processes as needed.
- Conduct compliance reviews of QHP applications, ensuring adherence to state and federal standards.
- Manage annual auto re-enrollment and health carrier communications.
- Monitor health insurance carrier information for accuracy in the Eligibility and Enrollment System.
- Develop corrective action plans for non-compliance and support carrier relations through issue tracking and engagement.
- Represent issuer interests during system requirement sessions and User Acceptance Testing (UAT).
- Process employer applications for SHOP eligibility and maintain detailed records per federal and state guidelines.
Minimum Requirements:
- Four (4) years of job-related experience OR two (2) years in a related compliance role.
- Familiarity with ACA, federal/state health insurance policies, and HIPAA regulations.
- Experience with ACA insurance plan credentialing and certification.
- Strong program management, data analytics, and reporting skills.
- Experience managing vendors and understanding health insurance carrier operations in Georgia.
- Knowledge of health technology systems.
Skills & Abilities:
- Excellent analytical, communication, and problem-solving skills.
- Strong organizational and project management abilities.
- Ability to navigate complex, evolving environments with multiple stakeholders.
What's in it for you?
This is an opportunity to make a meaningful impact on healthcare access in Georgia. If you thrive in a compliance-driven environment and have a passion for improving health insurance operations, we want to hear from you!