Commercial Markets Regulatory Specialist - Federal

Minneapolis, Minnesota
Aug 23, 2018
Oct 12, 2018
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.




At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.



Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.




Position Description

This position is responsible to monitor, analyze, and disseminate regulatory requirements for commercial health insurance markets.  Liaison to federal and/or state regulators to ensure clarity and communication.  Consult with business areas to identify requirements and ensure compliant solutions that support business goals.  Subject matter expert on applicable commercial regulations.  Respond to regulatory-related inquiries and represent department on federal commercial audits.  This position focuses on federal regulatory requirements.  Specific duties and responsibilities include:


Serve as primary liaison with federal regulators, including Centers for Medicare & Medicaid Services (CMS) and Center for Consumer Information and Insurance Oversight (CCIIO), for commercial markets requirements.  Collaborate with internal departments on analysis and interpretation of regulatory, sub-regulatory, and policy requirements.

Monitor, analyze, and distribute commercial market federal regulatory, sub-regulatory, and policy information, including federal laws, regulations, and guidance. Proactively identify impact to UCare's commercial products.  Educate departments about commercial market requirements. 

Build and maintain knowledge repository of commercial market regulations and sub-regulatory guidance. -

Consult on commercial reporting and filing activities to ensure compliance with federal requirements.  This includes, but is not limited to, annual form and rate filing, Medical Loss Ratio (MLR,) Risk Adjustment, reconciliation, and Quality Rating System. 

Lead analysis of regulatory issues due to contradictory guidance between federal and state regulatory entities.  Collaborate with Corporate Compliance to address compliance issues.

Manage access to Health Insurance Oversight System (HIOS), including liaison on security and system issues, to enable timely filings.

Serve as subject matter expert and super user for guidance distributed by Commercial Team, using Compliance 360.  Use defined workflows and work collaboratively on issue resolution and process improvements.

Serve as back up for Commercial Markets Regulatory Specialist - State.

Represent department in commercial market audits.

Other projects and duties as assigned.


Bachelor's degree.

Required Experience

Three years of work experience in a health plan, managed care, or health care delivery organization. 

Preferred Experience

Working knowledge of health insurance environment and core business functions.  Familiarity with regulatory submissions for commercial markets, including SERFF and HIOS.  Familiarity with federal regulatory requirements of commercial markets.  Understanding of state regulations that apply to commercial markets.  Project management.


UCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.


As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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