Regulatory Operations Analyst III
Fidelis Care - New Jersey
Job description
About the role
Centene is seeking a Regulatory Operations Analyst III to serve as a subject‑matter expert on federal and state legislation affecting its commercial and Marketplace health products. The analyst will interpret, summarize, and communicate regulatory changes to ensure compliance and support product approvals.
Key responsibilities
- Research, analyze, and summarize proposed and enacted legislation at federal and state levels.
- Conduct risk assessments on business applications, claims operations, and payment integrity processes.
- Maintain databases, reports, and reference materials related to regulatory, compliance, and audit activities.
- Lead regulatory interpretation for Commercial/ACA rules, adapting communication to varied audiences.
- Provide guidance on emerging regulations, audit inquiries, fraud‑waste‑abuse oversight, and payment integrity matters.
- Coordinate responses to regulatory inquiries, reporting requirements, and audits from state and federal agencies.
- Partner with Compliance, SIU, Payment Integrity, Claims Operations, Finance, and other cross‑functional teams to identify risks and support investigations.
Required profile
- Authorized to work in the United States without future visa sponsorship.
- Strong analytical skills with the ability to assess regulatory impact on multiple business functions.
- Excellent written and verbal communication, capable of translating complex regulations for diverse stakeholders.
- Proven ability to build trust‑based relationships and influence cross‑functional teams.
Required skills
What we offer
- Competitive benefits package.
- Flexible workplace arrangements.
- Opportunity to impact the health of 28 million members.
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Published 1 month ago
Expires 2 weeks from now
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Fidelis Care - New Jersey