Sr. Analyst, Regulatory Complaints

About the role:

The Sr. Analyst, Regulatory Complaints is an important resource for regulators, with responsibility for providing responses to potential concerns from State DOIs. You will partner with internal business departments to resolve member and provider complaints, identify issues and trends, and provide written resolution to regulators. You will meaningfully contribute to the development of relationships with regulators, and will be a resource to their teammates in the resolution of complaints.

You will report into the Sr. Manager, Regulatory Operations.

Responsibilities:

• Research and resolution of Regulatory Complaints
• Support identification of escalated issues by using Oscar processes
• Partner with leadership to share trends related to complaints received while proposing solutions to prevent recurrence
• Advise teammates on potential solutions to current regulatory complaints
• Develop successful relationships with state insurance regulators
• Compliance with all applicable laws and regulations.

Requirements:

• 3+ years of experience in health insurance customer service, claims, appeals, or Regulatory team
• 2+ years of experience working with regulators

Bonus points:

• Experience resolving health insurance claims and appeals
• Experience with the individual market health insurance plans
• Experience working cross-functionally with internal business partners