Regulatory Affairs Manager

Harbor Health is seeking a Regulatory Affairs Manager to support our health plan business by ensuring compliance with the Texas Department of Insurance (TDI), CMS, and other state and federal regulators. This role drives day-to-day regulatory affairs activities and reports directly to the Senior Director of Regulatory Affairs.

Responsibilities

• Monitor and analyze TDI, CMS, and other state/federal rulemaking, legislative changes, and industry trends affecting the organization; translate complex regulatory language into actionable guidance for senior management.
• Disseminate regulatory updates and changes to internal teams to ensure company-wide compliance; develop internal resources such as newsletters or briefs.
• Conduct regulatory research to support policy development and decision-making, with a focus on the Texas insurance market and NAIC model act adoption.
• Oversee preparation and submission of regulatory filings, including rate filings, policy/certificate form filings, network adequacy filings, and annual/quarterly financial and market conduct reporting; ensure accuracy and compliance with federal and state law.
• Serve as primary liaison for regulatory inquiries, market conduct exams, and complaint responses.
• Track state licensing, certificate of authority renewals, and producer/agent appointment compliance as applicable to plan operations.
• Collaborate with legal, compliance, operations, actuarial, network/provider relations, and product development teams to integrate regulatory considerations into health plan management.
• Support the design and enhancement of compliance frameworks to meet regulatory requirements; assist in internal audits and reviews to identify compliance risks and improvement opportunities.

Requirements

• Bachelor’s degree in Health Administration, Public Policy, Law, or a related field.
• Minimum of 5 years in regulatory affairs or compliance within the health insurance industry, with a proven track record of managing complex regulatory issues independently.
• Proficiency in navigating regulatory databases, preparing and submitting filings, and interpreting state and federal health insurance regulations.
• Experience with SERFF (System for Electronic Rate and Form Filing) or equivalent state filing systems.
• Familiarity with the Texas Insurance Code and TDI administrative rules.
• Strong analytical and problem-solving skills, excellent written and verbal communication abilities, and capacity to work effectively under pressure.
• Detail-oriented with a high level of accuracy, proactive in managing potential regulatory issues, and capable of influencing cross-functional teams.

Preferred Qualifications

• Graduate degree in health policy, law, business, or a related field.
• Experience with the Affordable Care Act and the Health Insurance Marketplace.
• Advanced knowledge of the Affordable Care Act, ERISA, HIPAA, and other relevant healthcare laws and regulations.
• Certification in Healthcare Compliance (CHC) or similar credentials.
• Leadership skills with the ability to mentor and guide team members, and exceptional stakeholder management capabilities.
• Experience with Medicare Advantage or ACA Marketplace regulatory filings.

Benefits

• Opportunity to shape the regulatory, legal, and compliance team.
• Collaborative and dynamic work environment.
• Competitive salary and benefits package.
• Professional development and growth opportunities.
• Transparent and unique company culture focused on transforming healthcare in Texas.

At Harbor Health, we’re transforming healthcare in Texas through collaboration and innovation, creating a member-centered experience that connects comprehensive care with a modern payment model.