Insurance Certification

2 weeks ago

atlanta, United States Focus People Full time

Position Summary:

Our customer is seeking a detail-oriented compliance specialist to support the certification and compliance of Quality Health Plans (QHPs) and Stand-Alone Dental Plans (SADPs) sold through state-managed ACA insurance carriers. Reporting to the Issuer Operations Manager, this role involves policy implementation, compliance monitoring, and effective communication with health insurance carriers.


Key Responsibilities:

  • Develop and enforce policies for QHP/SADP applications, timelines, and data corrections.
  • Review annual regulatory updates (CCIIO guidelines, Payment Parameters) and revise processes as needed.
  • Conduct compliance reviews of QHP applications, ensuring adherence to state and federal standards.
  • Manage annual auto re-enrollment and health carrier communications.
  • Monitor health insurance carrier information for accuracy in the Eligibility and Enrollment System.
  • Develop corrective action plans for non-compliance and support carrier relations through issue tracking and engagement.
  • Represent issuer interests during system requirement sessions and User Acceptance Testing (UAT).
  • Process employer applications for SHOP eligibility and maintain detailed records per federal and state guidelines.


Minimum Requirements:

  • Four (4) years of job-related experience OR two (2) years in a related compliance role.
  • Familiarity with ACA, federal/state health insurance policies, and HIPAA regulations.
  • Experience with ACA insurance plan credentialing and certification.
  • Strong program management, data analytics, and reporting skills.
  • Experience managing vendors and understanding health insurance carrier operations in Georgia.
  • Knowledge of health technology systems.


Skills & Abilities:

  • Excellent analytical, communication, and problem-solving skills.
  • Strong organizational and project management abilities.
  • Ability to navigate complex, evolving environments with multiple stakeholders.


What's in it for you?

This is an opportunity to make a meaningful impact on healthcare access in Georgia. If you thrive in a compliance-driven environment and have a passion for improving health insurance operations, we want to hear from you

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