Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position is responsible for reviewing new laws, regulations, and governmental agency guidance to ensure Horizon and its affiliates’ (collectively, “Company”) are in compliance and informed of key policy developments impacting health plans. The Specialist is responsible for providing regulatory and transactional support. Additionally, this position monitors operational compliance, and tracks pertinent legislative and regulatory developments. This position will communicate with Company departments and external contacts (outside counsel, state regulators, federal regulators, and customers) to prepare business correspondence and reports, as well as maintain and improve the multiple work streams that must operate in tandem with the business as well as regulations to ensure compliance with relevant legal frameworks. The incumbent is responsible for directly working with State and federal regulators to seek regulatory approval of Company contracts, marketing materials, and informational filings.

Job Responsibilities:

Primary subject matter resource for health policy developments impacting individual, group, and governmental health plans, offered and/or administered by the Company.Act as a health policy advisor and resource to the legal affairs team and organization on a range of legislative and regulatory developments and existing frameworks; update leadership on key observations and developments concerning regulatory compliance.Research, monitor, update, and maintain current knowledge of, developments in Federal, State, and local legislation, regulation, guidance, and enforcement actions, as well as industry guidelines affecting the Company’s business, including across health insurance services, third party administration of self-funded accounts, ancillary products, digital privacy, and producer/brokerage services.Prepare and maintain documentation pertinent to the Company’s certifications, trademarks, and licenses, including those related to the Blue Cross Blue Shield Association.  Collaborate across the Company to ensure the timely preparation and submission of all Company filings.Support Mandate Implementation Process by tracking status of new laws and regulations, drafting Legal Affairs Bulletins for new laws and regulations, and providing legal research and writing on existing laws and regulations, as needed.Oversee key controls associated with corporate transactions and contracts, including delegations of authority, off-shoring of services and/or data, and other contractual compliance, data governance, and privacy governance controls.Assure consistency and compliance of subscriber/member contracts, provider agreements, and other regulated contracts, with respect to benefit and network administration, and other Company operations.  Work closely with Contract Administration and Product Administration to assure the same, including active participation in cross-divisional internal committees to provide input on benefit administration and product renewals.Responsible for conducting research and proactively monitoring case law and agency enforcement actions with the goal of educating, recommending, and implementing new processes and solutions to problems.Perform legal analysis, investigation of facts, and coordinate document collections, preparations, and the maintenance of legal documents.Review non-standard benefits for compliance with applicable laws.Review and update ERISA plan documents, including Summary Plan Description templates and other group health plan documents.Perform additional tasks and lead additional work streams, from time to time and upon request, concerning the regulatory regime or corporate governance applicable to the Company’s business.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position.  This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Education/Experience:Bachelor's degree from an accredited college or university.Paralegal certification or Juris Doctorate preferredRequires a minimum of 5 years of business experience, preferably in the health insurance industry or as a health policy advisor.Requires 2 years of providing regulatory guidance (analyzing and interpreting laws and regulations) or compliance experience, preferably in health care.Experience with health insurance contract preparation and/or employee benefits plan drafting is preferred. 

Knowledge:

Requires general business knowledge of the health insurance industryWestlaw or Lexus experience preferredMust be proficient in legal researchPrefer working knowledge of health benefits plans, state and federal laws and regulations as they apply to group contracts, federally-funded governmental healthcare programs, insurers and familiarity with state departments of Insurance and/or Health.Mental Health Parity knowledge/background preferred, if relevant to position

Skills and Abilities:

Requires advanced analytical skills and the ability to present/recommend business solutionsRequires excellent organizational and prioritization skillsRequires the ability to work and communicate effectively with all levels of business, including senior and executive leadershipRequires excellent oral and written communication/presentation skillsEffective analytical & problem solving skills to propose creative solutions to regulatory needsCollaborative and client service focused to effectively deliver actionable requirements and solutionsMust demonstrate professional and ethical business practices and adherence to company standardsMust demonstrate the ability to effectively present information and respond to questions from groups of managers, internal and external clients, and company customersMust demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to adapt to new regulatory requirements and compliance regimes as appropriate

Salary Range:

$86,000 - $117,390

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.