Aca And Network Adequacy Analyst: Dora/division Of Insurance

State of Colorado
Full Time $5,959 - $7,747 Per year CO Anne Hsu, 768 S Grape St, Denver, CO 80246, United States
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Overview

Department Information

This announcement may be used to fill multiple vacancies.


The Department of Regulatory Agencies (DORA) is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.

Consumer protection is our mission.


DORA values and promotes diversity, supporting a workplace that is inclusive of people from different backgrounds and experiences; creating an environment that is reflective of our communities; promoting positive relationships; and putting forth unique perspectives to fulfill our mission. 

  • Employer-sponsored RTD EcoPass, with offices located at Civic Center Plaza, above the RTD Civic Center station and just a few blocks from RTD light rail. 

  • Extensive work-life programs such as flexible schedules, training and professional development opportunities on a wide variety of subjects, and more! 

  • Employee wellness programs, including the Colorado State Employee Assistance Program (CSEAP), which provides free, confidential counseling services.

  • Bike-to-work programs, including access to storage lockers and bike racks.

  • Flexible retirement benefits, including a choice of the PERA Defined Benefit Plan or the PERA Defined Contribution Plan, plus optional 401K and 457 plans.

  • Medical and Dental Health Insurance for employees and optional coverage for their dependents.

  • Life Insurance for employees, and optional coverage for their dependents.

  • Paid Time Off, including 11 paid holidays.

  • Short- and long-term disability coverage.

  • Tuition assistance program.

Description of Job

The Colorado Division of Insurance (DOI) regulates the insurance industry in Colorado. DOI helps consumers by answering their questions, investigating their complaints, and helping them to understand their insurance. The division regulates and monitors insurance companies in Colorado, as well as insurance agents, ensuring all are following the law.

The Life and Health Rates and Forms Team work unit exists to enforce Colorado health insurance premium rating statutes and regulations by reviewing insurance carrier premium rate filings to ensure that premium rates are not excessive, inadequate, or unfairly discriminatory. This is accomplished by ensuring health insurance products comply with statutorily mandated coverage as well as ensuring health insurance products are not misleading or deceptive through the review of policy form filings.

Position: SFA 4312

The Affordable Care Act (ACA) & Network Adequacy Analyst position is responsible for overseeing the work required for reviewing all Affordable Care Act major medical health insurance coverage rates, forms, network adequacy, reasonable modifications, and MHPAEA filings. This includes delegating questions or filings to the team members, planning for upcoming deliverables, and meeting deadlines required by CMS and Connect for Health for Colorado. Additionally, this position is responsible for coordinating and implementing a new phase of network adequacy compliance analysis, with the policy goal of establishing rules and procedures to fully analyze carriers’ provider networks to measure the adequacy and accuracy of their networks. This position supports and provides input on complex rate and filing issues when asked by other rate analysts on the team. This position supports the rates and forms director with researching complex policy topics, analyzing filings to support a compliance investigation, analyzing filings to support consumer complaints, and sending inquiries to carriers. This position assists with providing expertise on technical components of legislation as well as writing regulations and/or implementing new legislation or revising current regulations/bulletins for updated policy decisions.

Duties include, but are not limited to:

  • Monitoring regulatory developments at both the state and federal levels in order to harmonize their mutual requirements to fully integrate both into comprehensive network adequacy reviews; 

  • Conducting and ensuring ACA annual filing reviews run smoothly, deadlines are met, and communication is happening across multiple units in the DOI to resolve complex issues;

  • Enforcing the DOI’s network adequacy requirements, summarizing common network adequacy issues, and recommending potential policy solutions;

  • Tracking developments through the NAIC and participating in NAIC working groups, conducting research into NAIC model laws and regulations, and reviewing Colorado insurance statutes and existing regulations and bulletins.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

MINIMUM QUALIFICATIONS (MQs):


  • Graduation from an accredited college or university with a bachelor's degree in business, business administration, business management, healthcare administration, healthcare management, political science, public administration, public health, public policy, political science, risk management, and insurance, or a closely related field; AND

  • Four (4) years of professional* experience in at least one (1) of the following two (2) areas: 

    • Working in an insurance environment performing quantitative and qualitative analysis of the healthcare or health insurance market, including analyzing the practices of health insurance entities to determine compliance, or performing audits and/or examinations with a focus on health insurance; AND/OR

    • Performing data and/or statistical analysis to inform conclusions and/or recommend policy changes.

Document this experience in your application IN DETAIL, as your experience will not be inferred or assumed.  Part time experience will be prorated.

SUBSTITUTIONS: 


  • A combination of professional* work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree;

  • A master's or doctorate degree from an accredited college or university in a field of study related to the work assignment may be substituted for the required experience on a year-for-year basis.

  • Certification, registration, or licensure as a Market Conduct Management (MCM) designation or a similar professional designation will substitute for one (1) year of the required experience.

*Professional work involves exercising discretion, analytical skill, judgment and personal accountability and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is: uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods. 


Preferred Qualifications:

  • Demonstrated experience working in a state government position conducting research and analyzing insurance policies;

  • Demonstrated professional* experience designing health insurance networks,  interpreting insurance contractual requirements, and/or negotiating insurance contract terms and conditions; 

  • Demonstrated project management experience, including organizational skills and prioritization and delegating of tasks to other team members; 

  • Demonstrated professional* experience working in the health insurance industry performing Affordable Care Act (ACA) compliance/analyst functions to ensure company operations meet federal policies and rules, as well as regulatory requirements;

  • Experience designing health-related outreach and education processes to reach customer needs;

  • Demonstrated experience educating, informing, and/or working with senior leadership within an organization.

Required Competencies: The following knowledge, skills, abilities, and personal characteristics are required competencies and may be considered during the selection process (including examination and/or interview):

  • Demonstrated written communication skills, including the ability to convey information to various stakeholders in a clear, accurate, and concise written manner;

  • Demonstrated verbal communication skills, including the ability to convey information to audiences in a concise manner effectively;

  • Demonstrated attention to detail;

  • Demonstrated critical thinking and analytical skills, including having the ability to evaluate information to apply knowledge and to decide on the most appropriate course of action;

  • Demonstrated prioritization skills, including planning, organizing tasks, and managing work assignments;

  • Demonstrated time management skills, including the ability to multi-task to effectively manage competing and constantly changing priorities to meet tight deadlines;

  • Interpersonal skills, including relationship building and the ability to work collaboratively;

  • Complex problem-solving skills, including the ability to analyze situations and develop solutions;

  • Knowledge and familiarity with health insurance statutes and policies;

  • Demonstrated ability to understand and abide by workplace principles, practices and behaviors as internally identified and defined by the division and department;

  • Leadership and mentoring skills, including the ability to manage the workload of a work unit;

  • Demonstrated ability to read, understand, interpret, apply, and explain laws, rules, policies, and procedures;

  • Sound judgment and the ability to make decisions on a routine basis;

  • Reliability, dependability, and accountability, including consistent work attendance and time management;

  • Ability to maintain confidentiality of all confidential, sensitive and personal identifying information, personnel information, and any other confidential or proprietary information, as well as comply with all State and Department policies regarding professional conduct and professional practices;

  • Self-motivated, self-directed, self-starter, including the ability to work independently, learn new processes, utilize own knowledge and that of supervisor, and complete work with minimal supervision;

  • Demonstrated professional demeanor, including the ability to interact professionally with various stakeholders and internal staff;

  • Knowledge and understanding in the use of PC software applications including Microsoft Office (Access, Word, Excel, etc.), and Google Suite (Doc’s, Sheets, Slides, etc).

Conditions of Employment: Candidates who fail to meet the conditions of employment will be removed from consideration.

  • The successful passing of a reference check and/or, if required, a background check.

    • A reference check may include but is not limited to: contacting previous and current supervisors to verify employment and discuss performance, a review of the personnel file, a review of the performance record, etc.

    • The type of background check depends on the job duties of the position, and can include a review of any criminal record, credit report, and/or driving record.

  • This position requires the ability to travel up to 5% of the time, including staying over weekends when required; and the ability to transport equipment, including, but not limited to, laptop computers, printers, manuals, and supplies.

  • Effective September 20, 2021, employees will be required to attest to and verify whether or not they are fully vaccinated for COVID-19. Employees who have not been fully vaccinated may be required to submit to serial testing in the future. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination. Vaccinated employees must provide proof of vaccination.

  • Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer or Moderna vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine, as defined by the most recent State of Colorado’s Public Health Order and current guidance issued by the Colorado Department of Public Health & Environment.

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