Harbor Health
POSITION OVERVIEW
The Regulatory Affairs Manager plays a pivotal role in supporting Harbor Health's health plan business by ensuring regulatory compliance with the Texas Department of Insurance (TDI), CMS, and other applicable state and federal regulators, and by spearheading our health plan's day-to-day regulatory affairs activities. Reporting directly to the Senior Director of Regulatory Affairs, this position prepares and manages regulatory reporting, tracks key regulatory and legislative changes affecting the business, and prepares and submits regulatory filings, including rate and form filings.
POSITION DUTIES & RESPONSIBILITIES
Monitor Legislation and Rulemaking: Track 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: Effectively communicate relevant regulatory changes and updates to internal teams to ensure company-wide compliance. Develop internal resources, such as newsletters or briefs, to aid in the dissemination of critical regulatory information.
Conduct Regulatory Research: Perform regulatory research to support policy development and decision-making, with particular focus on the Texas insurance market and applicable NAIC model act adoption.
Manage Regulatory Filings: 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, ensuring accuracy and compliance with federal and state law. Serve as primary liaison for regulatory inquiries, market conduct exams, and complaint responses.
Support Licensing & Certificate of Authority Maintenance: Track state licensing, certificate of authority renewals, and producer/agent appointment compliance as applicable to plan operations.
Collaborate Across Departments: Work closely with other departments, including legal, compliance, operations, actuarial, network/provider relations, and product development teams, to ensure regulatory considerations are integrated into all aspects of health plan management and operations.
Support Compliance Initiatives: Assist in the design and enhancement of compliance frameworks to meet regulatory requirements. Support the compliance team in internal audits and reviews to identify compliance and regulatory risks and opportunities for improvement.
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
Required
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 a 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
Graduate degree in health policy, law, business, or 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.
WHAT WE OFFER
Opportunity to shape the regulatory, legal, and compliance team
Collaborative and dynamic work environment
An organization made of people who are passionate about changing the healthcare landscape
Competitive salary and benefits package
Professional development and growth opportunities
A transparent and unique culture
COMPANY OVERVIEW
At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!
EQUAL EMPLOYMENT OPPORTUNITY STATEMENT
Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.
