Director, Self Funding Contracts & Regulatory Job in Burbank, California US
Director, Self Funding Contracts Regulatory
This position is responsible for managing the Self-Funding Administrative Services (SFAS) Contracts and Regulatory operations, ensuring customer satisfaction and compliance with contractual obligations, as well as alignment with Kaiser's business strategies and goals. This includes the areas of; ASO contracts, stop-loss policies, Summary Plan Descriptions (SPD) and self-funding marketing materials. This position also supports National Accounts and Regional Marketing, Sales and Business Development (MSBD), National Case Installation and National Product Benefit Design by providing deep subject matter expertise and support on contracts compliance on both a pre-sale and post implementation basis. This is accomplished through a combination of personal production as well as management of the Contracts Regulatory staff within SFAS. Develop, manage and implement regulatory strategy to maintain existing self funded business. Responsible for the direction and ensuring regulatory compliance with government requirements and KPIC's contractual obligations in support of KPIC's goals and the organization's mission/vision. Develop guidance for adherence of KPIC's contractual requirements; synchronize with industry standard and other high risk areas. Establishes a strong program for effective partnership with regulatory bodies; national regional operations; national and regional product development areas; rating and actuarial divisions and national and regional sales and marketing department's. Researches current and upcoming federal and state regulatory guidelines, laws and statutes; compliance issues and recommends changes and/or analyzes impacts to assure compliance with contract obligations. Ensures all relevant external regulatory requirements are identified and develops processes to disseminate information on regulatory compliance requirements to appropriate personnel. Primary Responsibilities: Reports to SFAS Executive Director Conduct direct contract negotiations with all new and renewing self funded Plan Sponsors. Oversees the implementation of tactical solutions which support strategic plans Drives strategic direction and acts as a change leader Ensures the day to day operation and management of assigned regulatory services, in accordance with contract, all applicable regulatory requirements and laws, and policies and procedures. Establishes strategy and tactics within area of responsibility, and may contribute to the formulation of a national strategic goal for KPIC. Ensures plans in place to accomplish area goals, results tracked and resources appropriately allocated across area of responsibility. Monitors the results of functional area and processes. This position may be responsible for a staff function in addition to having subordinate employees. Directs managers and highly technical individual contributors Manages HR/People processes for the organizational area including performance For Plan Sponsor ASO Contract Templates: - Develop text and secure approvals from SFAS Executive Management, Legal and KPIC Regulatory - Coordinate submission to appropriate regulatory agencies, track for timely response, make changes necessary for approval and operationalize either as a standard template or single group contract For Stop-Loss Policies and Riders: - Develop text and secure approvals from SFAS Executive Management, Legal and KPIC Regulatory - Coordinate submission to appropriate regulatory agencies, track for timely response, make changes necessary for approval and operationalize either as a standard template or single group contract For Plan Documents and Benefit Materials (including SPDs): - Develop text and secure approvals from SFAS Executive Management, Legal, Sales Marketing and KPIC Regulatory - Coordinate submission to appropriate regulatory agencies, track for timely response, make changes necessary for approval and operationalize either as a standard template or single group contract Qualifications: Basic Qualifications: - Eight (8) to ten (10) years of management experience in health care/insurance regulatory compliance environment with three (3) to five (5) years of management experience required - Experience in managing large regulatory compliance audits and investigations, liaison to government agencies - Typically requires a bachelor's degree in related area - Advanced degree in related area preferred - Paralegal or law degree preferred - Requires extensive working knowledge of government regulations agencies particularly that of various state's Department of Insurance and/or other agencies such as CMS, (Medicaid) DMHC, (Department of Managed Health Care); Department of Labor (ERISA);DHS (Department of Health Services MediCal) affecting compliance activities required for health care administration; and thorough knowledge on HIPAA issues and requirements - Demonstrated ability in performing thorough investigations, developing logical conclusions and effective analytical reports, complex problem solving and high-level negotiations - Complex knowledge and understanding of Kaiser's health care products and its strategic direction and how they fit in the industry and complex knowledge of current industry health care standards and future health care proposals and identify Kaiser's regulatory strategic direction - Complex knowledge of state and federal laws and ability to analyze case laws that impacts existing and proposed Kaiser products and the health care industry