This position will report to the Lead Counsel for Commercial & Government Markets who, in turn, reports to Guardian’s EVP & Chief Legal Counsel.
This new role has been created in response to increasing demand for legal expertise as Guardian’s strategy regarding government programs for dental, vision and hearing products, among other things. The role will align and build out disciplined and coordinated efforts around interpretation and application of regulatory guidance on product and network initiatives and risk management requirements. This is a build out opportunity for an experienced and knowledgeable attorney who can operate with minimal guidance, be highly customer focused, demonstrate solid business judgment, strong negotiation and legal skills and instinct with flexibility to meet diverse needs of various business leaders and initiatives.
This role will drive involvement and partner closely with business area attorneys, product, marketing, distribution, analytics, and technology leaders across the company to identify insights, highlight problems and provide critical input into key decisions to execute on the Company’s strategy. The ideal candidate has outstanding written and verbal communication skills, is practical, a doer and has outstanding business judgment.
This position provides legal support for Guardian's Commercial & Government Markets (C&GM) division, focusing primarily on matters related to group commercial and government dental and vision insurance with an emphasis on government programs. Specific support expertise includes counseling of internal clients, coordinating work performed by outside counsel, negotiating and drafting contracts, including provider and Medicaid/Medicare agreements, providing regulatory advice with attention to health matters, and ensuring compliance with Company guidelines.
- Provide crisp, pragmatic real time advice on business matters, to internal business clients as requested on agreement terms, regulatory or legal requirements, company policies, processes, approval requirements, and legal issues
- Collaborate with and facilitate cross-team decision-making among the network team, product team, legal team, operations and other various internal departments and clients.
- Coordinate with the business stakeholders to ensure consistency of approach and best practices for network development, credentialing, and client arrangements, where appropriate.
- Review and prepare commercial agreements, provider agreements, network leasing agreements, MCO agreements and other documents, counseling clients on related regulatory and other legal issues.
- Ensuring company’s compliance with relevant federal and state laws, including Health Information Portability and Accountability Act (HIPAA) and all other relevant federal and state laws.
- Identifying and providing counsel on a range of legal issues related to the government and commercial product development and distribution activities of C&GM, including the collection, use, sharing and protection of regulated information under relevant federal and state law.
- Providing analysis and legal counsel related to the permissibility of new business initiatives as it relates to federal and state insurance matters in supporting dental and vision products.
- Ensure processes are in place for a robust governance program that includes company policies, procedures, and guidance covering all legal matters in support of federal and state laws.
- Enhancing healthcare law education and awareness across the organization.
- Enhancing effective systems for monitoring, auditing, and measuring the effectiveness of the Healthcare law programs to identify successes, potential areas of vulnerability, risks and areas for further improvement. Where required, develop a mitigation process to protect the company and its businesses and functions and ensure compliance to protect business and reputational risk in the collaboration with the Compliance teams.
- Working closely with internal Privacy Counsel, ensuring the implementation, maintenance and revision of, and adherence to, the organization's policies around Protected Health Information (PHI) and, generally, other forms of regulated privacy and confidential information, as necessary to comply with federal and state laws and the company's internal privacy policies and practices.
- Continuing knowledge of current healthcare regulations, including contractual and operational issues management involving HIPAA and other regulations and laws affecting C&GM.
- Developing external contacts and participating in professional organizations that will provide benchmarks for healthcare law internally and enhance the understanding of the external environment to anticipate new trends and developments in the field.
- Strong relationship orientation and agility to navigate across the organization
- Ability to leverage direct and indirect resources
- Excellent written and verbal communication skills to various levels of the company while also synthesizing complex situations for business partners
- Ability to respond to issues with a sense of urgency, be a trusted business partner, and convey maturity and professionalism
- Experience interfacing with Executive Management
- Experience with developing and implementing commercially-aligned legal counsel, including interaction with executives, internal and external stakeholders, outside counsel and regulatory personnel.
- Knowledge of commercial and government healthcare laws and regulations.
- Ability to address complex and challenging issues; communicate and influence effectively with business leaders at all levels to optimize risk management, productivity, and communication.
- Ability to work in a dynamic, hands-on manner; respond to questions from business areas and a complex subsidiary organization.
- Respect for diversity and ideas of others; willingness to collaborate in a fast-paced team environment with effective consultative and influencing skills.
- Experience drafting contracts, including business associate agreements.
- Experience working with state insurance departments on ranging legal matters.
- Demonstrated leadership ability in an organizational setting, law firm and/or corporation.
- Integrity and strong interpersonal skills are essential to success.
- Strong project management skills; outstanding written and verbal communications skills are essential.
- Experience in privacy compliance and data security including policy and corporate and regulatory knowledge
- Self-motivated, sound judgment, professionalism and discretion
- Ability to multi-task in a fast-paced environment and pay attention to detail
- Strong organizational and project management skills
- Ability to think strategically, along with the business and compliance
- Manages multiple projects and deliverables and executing a range of complex tasks and analyses simultaneously
- Adapts to changing business priorities and environments
- This is a practical, non-academic position
- Highly business and customer focused with demonstrated experience
- Continuously strives to provide superior products and customer service
- Expresses oneself in an open and honest manner
- Demonstrates self-awareness and embraces feedback
- Respect for diversity and ideas of others; willingness to collaborate in a fast-paced team environment
- Active listener with a demonstrated history of innovation, problem solving and a commitment to excellent client service
- Ability to address complex and challenging issues and communicate effectively with business partners at all levels to optimize risk management, productivity, and compliance
- Continuously strives to provide superior work product and customer service
- Expresses oneself in an open and honest manner
- Demonstrates self-awareness and curiosity
- Minimum of 10+ years legal experience in the various commercial disciplines gained in any combination of a major law firm and/or corporate in-house insurance where healthcare law has been the primary focus.
- J.D. from a national law school with excellent academic performance demonstrated.
- Prior admission to at least on state bar and admission to NY bar within one year of hire or NY in-house limited license required.
- 25% Travel - travel to/from our NYC to Bethlehem, PA or Holmdel, NJ offices, will be required, as needed.