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please see: https://idahoworks.gov/jobs/2362065 Looking for a way to
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Join PacificSource and help our members access quality, affordable care!
**PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard to
status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion, color,
national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion:** PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual differences
are appreciated, respected and responded to in ways that fully develop
and utilize each person\'s talents and strengths.
Responsible for the development and accuracy for all commercial
regulatory filed forms. This position requires independent judgement and
decision making aptitude in the coordination and submission of Qualified
Health Plan (QHP) binder filings submitted through NAIC System for
Electronic Rates and Forms Filing (SERFF) by required deadlines. Role is
a primary liaison between PacificSource and CMS and state insurance
divisions in Oregon, Idaho, Montana for commercial filed documents.
Essential Responsibilities:
Responsible for the accuracy, creation and development of commercial
regulatory documents.
Coordinate, as the subject matter expert, and must demonstrate
independent judgement on the internal review and decisions of new
and revised commercial regulatory documents to achieve filing
approvals.
Prepare state and federally accurate and compliant forms, submit all
commercial required documents to respective state and/or federal
regulators by established regulatory submissions due dates.
Responsible for the coordination, preparation and filing of all
Association and client specific documents as required by the state.
Must be able facilitate correspondence and must possess the
specialized skillset to ensure filing approvals.
Lead cross functional team meetings throughout the filing process to
ensure regulatory inquires meet state required timelines.
Lead and facilitate discussions with operational areas in the
company for form and binder filing objections received from state
regulators. Must possess operations knowledge to script and submit
responses within required timelines and to achieve filing approvals.
Collaborate with internal departments to ensure benchmark
requirements are met, collect and submit templates and supporting
documentation required for QHP binder filings.
Ensure a working collaborative relationship with state regulators to
aid in filing and objection process to ensure filing approvals.
Serve as a subject matter expert in providing direction to internal
departments with the implementation of approved health insurance
contracts, policies, and related documents.
Maintain records of required regulatory documents filed with the
respective federal and state agencies.
Document and maintain records throughout the year of issues that are
identified that will require revisions for the following filing.
Participate and provide direction in the review of negotiated
documents that do not require state regulatory filing.
Review policy and procedures with all operational areas to ensure
administration and processes are consistent with approved filed
language.
Actively participate as a key team member in department meetings.
Collaborate and create policies and procedures, job aids and other
appropriate documentation to perform essential job functions.
Assist Business Analysts, as needed. Review benefit summaries,
negotiated language for materials and forms, and other materials as
created/altered.
Supporting Responsibilities:
Provide assistance for Management and other internal departments as
required for efficient functioning of the department.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and
regulations concerning confidentiality and security of protected
health information.
Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of three years of health insurance
experience working with regulatory entities and SERFF filings required.
Education, Certificates, Licenses: High School diploma or equivalent
required. Bachelor\'s degree in business or a related field is
preferred.
Knowledge: Strong proficiency with interpretation of state and
federal health insurance rules and regulations. Must possess a
comprehensive understanding of PacificSource products, all filed
commercial documents operations, and related materials. Strong research,
analysis, organizational, and interpretative skills to provide direction
and decisions to operational areas. Ability to research and understand
state and federal regulatory requirements for filing docum
