Job Description:

Thoroughly prepares, researches, and completes California Department of Managed Health Care (DMHC) reports and amendment filings, business partners/carrier reporting requirements, and any other requirements set by state and federal agencies (including, but not limited to: Medicare Advantage (MA), Department of Insurance (DOI), and Employee Retirement Income Security Act (ERISA)).

Responsibilities:

• Reviews related regulations and performs analysis to assure all requirements are met and filed within the deadline.
• Thoroughly and timely tracks reporting deadlines by month and logs all in-process and completed reports.
• Prepares and/or oversees internal claims and quality management/utilization management audit results and findings.
• Prepares documents for presentation to the Quality Management Committee, Public Policy Committee, Board of Directors, and Management Team.
• Provides oversight with the compliance work plan and monitoring functions and activities including risk assessment

Qualification:

• Excellent verbal and written communication skills with the ability to formulate document content.
• Ability to maintain the confidentiality of company documents and information
• Experience with regulatory filings, particularly with California Department of Managed Health Care (DMHC)
• Experience performing monitoring and oversight activities
• Regulatory research experience
• Experience with external or internal audits
• Knowledge of Department of Insurance and CMS/Medicare regulations, a plus