Legal Regulatory Affairs Analyst

Centene Corporation Woodland Hills, CA
Position Purpose: Research and respond to inquiries from regulatory agencies, Health Net members and providers regarding their concerns and disputes. Provide information to regulatory agencies, members and providers on their issues regarding the benefits and limitations of their coverage.

Conduct extensive reviews via research of member and provider disputes submitted by regulatory agencies. (DMHC, DOI) Determines sources and relevance of findings.

Respond to members, providers and regulatory agencies as it deals with regulatory complaints, regarding their concerns and disputes by providing information on their issues and final decision regarding benefits and limitations of their coverage and how it relates to any issues raised.

Evaluate and analyze inquiries submitted by the regulatory agencies and identify issues that require corrective action by Health Net. Research, analyze and interpret various complex issues to support final decision.

Work with Sales, Provider Services, Contracts, Membership, Appeals and Grievances by communicating information regarding identified problems and request improvement/corrective action.

Assemble documentation to support Health Net in any cases brought against the company by the Enforcement or Regulatory agencies.

Education/Experience: High School degree required; college degree preferred. Three to four years in health care industry with legal research claims systems and/or regulatory issues experience.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.