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Director of Regulatory Compliance- Large Group Health Insurance

1 month, 2 weeks ago
United States
Full-time
Lead
Compliance Manager
Operations
HIPAA
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 4

Description

  • Lead the regulatory workstream for new state entry, including licensing, foreign qualification, and producer/agency licensing requirements.
  • Research and map state-specific insurance requirements to support expansion decisions and sequencing.
  • Build a repeatable new-state playbook covering licensing steps, filing timelines, and ongoing obligations.
  • Own or partner on SERFF rate and form filings and manage responses to DOI objections.
  • Track filing deadlines, renewals, and periodic reporting across all states of operation.
  • Maintain a master compliance calendar and filing tracker.
  • Serve as the primary contact for the Texas Department of Insurance, other state DOIs, NAIC, and CMS as applicable.
  • Manage regulatory examinations, market conduct exams, inquiries, and complaint escalations.
  • Monitor legislative and regulatory changes and translate them into business impact assessments.
  • Design, implement, and maintain compliance policies, procedures, internal controls, monitoring, and testing programs.
  • Partner with Legal and HR to ensure producer/agent appointment, licensing, and training requirements are met.
  • Support enterprise risk management reporting, compliance updates, and board/leadership reporting.
  • Advise Product and Actuarial teams on regulatory feasibility during product design.
  • Train and support Claims, Member Services, and Sales teams on regulatory requirements affecting their work.

Requirements

  • Bachelor's degree required; JD, MBA, or other relevant advanced degree is a plus.
  • 8+ years of progressive experience in health insurance regulatory compliance.
  • Direct experience at a fully insured commercial health carrier (HMO, PPO, or indemnity).
  • Hands-on experience with state DOI rate/form filings and SERFF.
  • Experience supporting or leading multi-state licensing and market entry for an insurance carrier.
  • Strong knowledge of state insurance codes, NAIC model laws/regulations, and relevant federal requirements including ACA market reforms, HIPAA, and COBRA/ERISA as applicable.
  • Experience managing or responding to regulatory examinations and market conduct exams.
  • Familiarity with health insurance regulatory reporting requirements such as Mental Health Parity, Prompt Pay, Market Conduct, Gold Card, Balance Billing, and Network Adequacy.
  • Excellent written and verbal communication skills with the ability to translate complex regulatory requirements into practical guidance.
  • Highly organized, self-directed, and comfortable working with significant ownership in a lean, fast-moving organization.
  • Excellent time management and organizational skills to maintain reporting calendars and state contacts.
  • Must live in the United States within the CST or EST time zones.
  • Must have a dedicated private work area and the ability to keep sensitive documents secure.
  • Must have access to a high-speed internet connection.
  • Preferred: Experience expanding a Texas-domiciled or Texas-licensed carrier into additional states.
  • Preferred: Familiarity with Texas Department of Insurance requirements and relationships within TDI.
  • Preferred: Experience building a compliance function from an early stage.
  • Preferred: Working knowledge of health plan network adequacy and provider contracting compliance requirements.
  • Preferred: Professional certification such as CHC, CPCU, HIA, or AHIP fully insured/HMO designations.
  • Preferred: Experience with fully insured group employer products specifically.
  • Preferred: Ability to assist with ERM and ORSA-related risk management reporting.

Benefits

  • Remote position with a fully distributed company.
  • Company headquarters in Dallas, Texas.
  • Weekday business hours of 9-5 CST.

Interested in this position?

Apply directly on the company website

Apply Now

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