Health Plan Operations and Compliance Analyst

Carrier Operations & Compliance Analyst

Location: Atlanta, GA. Hybrid, 3 days in office/2 remote

About the Role:

Are you someone who thrives in a fast-paced, evolving environment and enjoys working with health insurance carriers?

Our public sector customer is looking for a startup-minded person to join their team and play a key role in ensuring the compliance and certification of Quality Health Plans (QHPs) and Stand-Alone Dental Plans (SADPs) sold through Georgia Access and the Small Business Health Options Program (SHOP).

This role is perfect for someone who enjoys working with the Affordable Care Act (ACA) carriers in Georgia and supporting health insurance regulations.

Key Responsibilities:

• Carrier Management: Build and maintain strong relationships with ACA health insurance carriers in Georgia. Support regular meetings and communication with carriers to ensure compliance and successful plan certification.
• Plan Certification: Manage the annual certification process for health plans in the spring and summer, including monthly issuer certificate reviews.
• Compliance & Reporting: Conduct periodic compliance reviews of health insurance carriers, ensuring adherence to both federal and state regulations. Develop corrective action plans for any non-compliance.
• Team Collaboration: Work closely with eligibility and enrollment teams to ensure accurate carrier and plan information. Support open enrollment processes.
• Data Management: Manage plan data in the Eligibility and Enrollment System, ensuring accuracy and completeness.
• Problem-Solving: Navigate a startup-like environment with many unknowns as policies are refined. Be proactive in seeking answers and helping the team succeed.
• IRS Reporting: Provide data reports to the IRS as requested.

Who You Are:

• You have experience working with an authorized issuer to provide health insurance services in Georgia, preferably in an insurance or hospital background.
• You understand healthcare and health insurance regulations and can easily navigate the resources available to you.
• You are comfortable working in a startup environment, where processes and policies are constantly evolving.
• You’re a proactive problem solver who asks questions, looks for answers, and is always searching for ways to help your team.
• You thrive in a collaborative environment but can work independently with minimal supervision.
• You are skilled in managing multiple tasks, such as compliance reviews, plan certifications, and vendor management, while meeting deadlines.

What You Bring:

• Understanding of the ACA and health insurance regulations in Georgia.
• Proven experience working with insurance carriers or hospitals and managing relationships with key stakeholders.
• Strong analytical, problem-solving, and project management skills.
• Excellent written and verbal communication skills for working across teams and with external partners.
• Familiarity with health technology systems (Eligibility and Enrollment Systems, HIPAA guidelines).
• Ability to work effectively in a complex, evolving environment with multiple stakeholders.
• A positive, solution-oriented attitude with high integrity and business judgment.

Education & Experience:

• 4-5 years of job-related experience.
• Experience managing healthcare vendors, working with health insurance carriers, and knowledge of health technology systems.

Why Should You Join This Team?

• Opportunity to work with ACA carriers in Georgia and directly impact healthcare plan certifications and compliance.
• Be part of a collaborative, startup-like environment where your input helps shape processes and policies.
• Work in a field that combines healthcare and insurance, making a difference in people’s access to quality health plans.