Regulatory Operations Analyst III

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

About the Role

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 analyses, 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.
• 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.
• Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings.

Requirements

• Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required.
• Master's Degree in a related field or Juris Doctorate degree may be considered in place of experience.
• 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.

Pay

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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Benefits may be subject to program eligibility.