Job Family:

Travel Required:

Clearance Required:

What You Will Do:

The Healthcare Review/Audit Policy Member is responsible for monitoring federal/state policy changes and court rulings relevant to the Exchanges (e.g., changes impacting the Advanced Premium Tax Credit (APTC)/Qualified Health Plan (QHP) eligibility, and Special Enrollment Periods (SEPs), and through reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation; Assesses the impact of those changes on Exchange Improper Payment Measurement (EIPM) methodology, including review unit logic, scripts, and review tools, and determines where updates are required; Develops policy update deliverables...