Centene Corp

Regulatory Operations Analyst III

Centene Corp • $70K — $126K *
US-Anywhere
+ 19 other locationsRemote
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required.
  • 4+ years experience in health insurance, legal, compliance or related field required.
  • Experience reviewing regulations and providing interpretations for various audiences preferred.
  • Experience in commercial health insurance or Medicaid managed care strongly preferred.
  • Proficiency with Excel and familiarity with reporting or analytics tools strongly preferred.

Responsibilities

  • Identify and summarize proposed or enacted legislation related to Centene's commercial product.
  • Perform independent risk assessments impacting business operations.
  • Maintain relevant databases and reference materials for legislative activities.
  • Conduct comprehensive regulatory analysis and disseminate key updates.
  • Lead regulatory interpretation processes and adapt communication based on audience.
  • Guide business partners on emerging regulations and compliance inquiries.
  • Coordinate with cross-functional teams on regulatory inquiries and audits.

Benefits

  • Comprehensive benefits package including health insurance and 401K.
  • Tuition reimbursement to support ongoing education.
  • Paid time off plus holidays to encourage work-life balance.
  • Flexible work arrangements allowing remote, hybrid, or in-office schedules.
  • Opportunities for stock purchase plans and other incentives.
Full Job Description

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics.  Performs state or federal policy research, regulatory reporting, and regulatory change monitoring with a goal of supporting compliance, regulatory readiness, and formal regulatory approval of commercial and Marketplace products.

  • Identifies, analyzes and interprets proposed or enacted legislation related to Centene's commercial product at the federal and state level and communicates findings to impacted departments. 
  • Independently performs risk assessments, including impact to business applications, claims operations, payment integrity processes, and downstream output. 
  • Maintains databases, reports, exhibits, and other reference materials related to legislative, regulatory, compliance, audit, and inquiry activities. 
  • Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level. 
  • Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level. 
  • Provides guidance to business partners regarding emerging regulations, regulatory inquiries, audit activity, fraud, waste and abuse (FWA) oversight, and payment integrity matters.
  • Coordinates regulatory inquiries, reporting requirements, exhibits, audits, and requests from state and federal agencies, maintaining accurate and timely responses in partnership with operational stakeholders.
  • Partners with Compliance, Special Investigations Unit (SIU), Payment Integrity, Claims Operations, Finance, and other cross-functional teams to identify regulatory risks, support investigations, and analyze operational trends.
  • Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues. 
  • Ability to determine appropriate approach for solving regulatory problems. 
  • Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives. 
  • Attends cross-departmental meetings as department representative, provides guidance to the business related to commercial regulatory requirements and appropriately escalates matters to management.
  • Develops solutions to address potential legal, contractual and regulatory issues while working closely with Legal, Compliance, Payment Integrity, and other operational stakeholders. 
  • Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs. 
  • Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market. 
  • Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings.

Education/Experience:

  • Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required.  Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred.
  • 4+ years experience in health insurance, legal, compliance or related field required.
  • Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred.
  • Experience in commercial health insurance, Medicaid managed care, claims operations, compliance, payment integrity, or related healthcare operations preferred.
  • Experience partnering with Special Investigations Unit (SIU), Compliance, Fraud, Waste and Abuse (FWA), Payment Integrity, or related operational teams strongly preferred.
  • Experience supporting claims operations, including medical claims processing, provider billing practices, payment accuracy, reimbursement workflows, or claims-related regulatory activities strongly preferred.
  • Experience analyzing claims data, billing trends, overpayment activity, provider utilization patterns, or operational risk indicators strongly preferred.
  • Experience supporting regulatory audits, investigations, agency inquiries, corrective action plans, or regulator-facing responses strongly preferred. 
  • Proficiency with Excel and experience using reporting, analytics, or business intelligence tools such as Power BI, SQL, SAS, or similar platforms strongly preferred.
  • Experience within Medicaid managed care, including exposure to Medicaid Fraud Division (MFD), Medicaid Fraud Control Unit (MFCU), payment integrity, third-party liability (TPL), or recovery activities strongly preferred.

By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified.

Pay Range: $70,100.00 - $126,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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