* Bachelor’s Degree in Finance, Accounting or related field, required. Master’s Degree, preferred.
* Minimum of seven (7) years progressive insurance regulatory experience, including regulatory standards and reporting requirements. Either Governmental regulatory reporting (MLTC, FIDA, Managed Medicaid) or Commercial (NAIC reporting).
* Extensive knowledge of the health insurance marketplace, financial analysis, current reimbursement issues, budgets, and operational analysis, required.
Develops and establishes policies and procedures to optimize operations. Directs regulatory reporting (Operational and Financial) support activities of multiple staff, including interdepartmental information reporting. Manages materials, technology and human resources. Ensures compliance with applicable laws, regulatory standards and internal policies. Directs activities of all departmental staff to meet short and long-term strategic goals regarding regulatory reporting capabilities.
- Directs operations to achieve strategic operating goals and objectives. Tracks and reports on department operational performance indicators related to regulatory reporting.
- Evaluates, develops and establishes policies and procedures to improve efficiency of current systems/processes/functions utilized in preparation and submission of regulatory reporting.
- Evaluates, develops and establishes quality management and performance improvement programs.
- Modifies financial programs consistent with changing regulatory and fiscal environment.
- Ensures financial operations are compliant with laws, regulations and standards including but not limited to; federal, state and local laws and pertaining to financial and operational regulatory reporting.
- Update and validate new regulatory reporting software releases for NY State quarterly and annual Operating Reports for all Governmental insurance products.
- Update and validate new regulatory reporting software releases for NAIC and NY State supplemental quarterly and annual Operating reports for all Commercial insurance lines of business.
- Direct all Finance and Actuarial staff in planning, scheduling and preparation of all requirements for both Governmental and Commercial quarterly and annual regulatory filings. Maintains and reporting submission date calendars and communicates to Controller and CFO.
- Direct all aspects of statistical reporting utilized in preparation of NYS quarterly and annual Operating Reports including working with Government Operations staff to validate enrollment and staffing information.
- Co-direct (with Director, Insurance Accounting) collection and maintenance of accounting and financial data utilized in both Governmental and NAIC regulatory filings.
- Actively participate in insurance trade association, NYS and other regulatory agency meetings, calls and webinars relating to statistical and financial reporting and represent interests of Both NSLIJ Health Plan and CareConnect.
- Analyze, assess and update senior management regarding regulatory developments, changes and communications for both Goevernmental and Commercial Insurance products.
- Manages and evaluates direct reports and oversees the management and evaluation of indirect reports.
Performs related duties, as required.