Job Brief

This role is hybrid and requires onsite presence 3 days/week at our Newtown Square, PA location.

Responsibilities:

This position is an in-house counsel position that will assist in advancing the important business objectives, interests and image of the company through various activities, with a focus on providing legal support to the company’s commercial line of business. The ideal candidate will have Commercial Insurance, and/or Medicare managed care subject matter expertise and an ability to develop an understanding of the business and operational goals of assigned internal clients, proactively advise business partners on a wide variety of matters, and work collaboratively with other attorneys on matters related to legal and regulatory compliance.

The position will be primarily responsible for:

• Advising the business on a broad range of legal, regulatory, and compliance issues, to mitigate risks associated with the company’s Exchange product line.
• Identifying business and legal risks and working with the business to provide solutions that balance legal issues and business objectives.
• Researching local jurisdictional requirements for licensure and other market entry regulatory requirements, and providing guidance and assistance in the timely completion of application materials
• Policy drafting experience and in-depth knowledge of statutes/regulations including declarations page and endorsement requirements/drafting, cancellation and non-renewal statutes/regulations,
• Knowledge of marketing requirements and review of same
• Knowledge and review/drafting of internal policies, training materials, notifications and procedures, and external-facing materials such as policy/coverage forms, to ensure compliance with related regulatory requirements
• Knowledge and experience in drafting and reviewing agent/company agreements and agent licensing including agent terminations, disputes and broker of record letters
• Coordinating Market Conduct Examinations
• Handling policy holder disputes/claims
• Dealing with state insurance departments/regulators
• Drafting and negotiating contract vendor/supplier contracts that support the company’s Exchange product.
• Experience in internal accounts receivable/payable requirements including handling of premium
• Keeping up to date and advising on the potential impact of new and proposed healthcare laws and regulations to ensure continued compliance.
• Operating with a high degree of integrity, in alignment with company mission and culture.
• Performing other special assignments, strategic projects, or duties as needed.

Education/Experience:

• JD required
• License to practice law in at least one state.
• Knowledge and experience in Health Care and laws and regulations pertaining to commercial insurance products, Provider contracts, business transactions, labor/human relations and/or vendor contracts.
• Experience in counselling in a corporation/law firm specializing in accident and health insurance. Exchange product experience helpful
• 10 + years of experience after receiving law degree.

Other Skills:

• Demonstrated analytical skills and strong legal project management and facilitation skills.
• Strong ability to provide risk assessment/risk mitigation support and strong negotiation skills.
• Ability to work both independently and collaboratively, provide leadership, influence organization behavior and create alignment across organizational lines.
• Excellent written and verbal communication skills, and the personal presence, credibility, and the professional demeanor necessary to interact with company management, regulatory bodies, and business units with persuasiveness and confidence.
• Collaborative team player with an ability to effectively manage competing priorities.
• Ready, willing and able to assist with new needs and comfortable with uncertainty and ambiguity.
• Excellent judgment and the ability to prioritize and make difficult decisions quickly.