Director of Regulatory Compliance- Large Group Health Insurance

Position Summary

Key Responsibilities

Multi-State Expansion & Licensing

• Lead the regulatory workstream for entry into new states, including certificate of authority applications, insurer licensing, foreign qualification coordination, and producer/agency licensing requirements.
• Research and map state-specific insurance regulatory requirements (mandated benefits, network adequacy, prompt pay, grievance/appeals, rate and form filing) to inform go/no-go and sequencing decisions for expansion states.
• Build a repeatable "new state playbook" that captures licensing steps, filing timelines, and ongoing obligations so future state launches become faster and lower-risk.

Filings & Regulatory Submissions

• Own or closely partner with Actuarial on SERFF (System for Electronic Rate and Form Filing) submissions for rate and form filings, ensuring accuracy, completeness, and timely response to DOI objections.
• Track and manage all state filing deadlines, renewals, and required periodic reporting (financial, market conduct, statistical, network adequacy, etc.).
• Maintain a master compliance calendar and filing tracker across all states of operation.
• Assist the CFO and Chief Actuary in maintaining the financial reporting calendar (this position is not responsible for financial submissions).

Regulatory Relations

• Serve as the primary point of contact with the Texas Department of Insurance and, as applicable, other state DOIs, NAIC, and CMS on matters not involving Medicaid/Medicare (e.g., ACA market reforms, exchange requirements if applicable).
• Manage regulatory examinations, market conduct exams, inquiries, and complaint escalations; coordinate responses across departments.
• Monitor legislative and regulatory developments (state and federal, including ACA/ERISA where relevant to fully insured group business) and translate changes into actionable business impact assessments.

Compliance Program & Policy Development

Design, implement, and maintain Evry Health's compliance policies, procedures, and internal controls (e.g., complaint handling, prompt pay, appeals/grievances, producer oversight, advertising/marketing review, privacy practices coordination with HIPAA compliance).
Establish a compliance monitoring and testing program to proactively identify and remediate gaps ahead of exams or audits.
Partner with Legal and HR to ensure producer/agent appointment, licensing, and training requirements are met in all operating states.
Risk Management & Reporting
Support the Chief Actuary in enterprise risk management activities related to regulatory and compliance risk, including input into ORSA-related processes, risk registers, and board/leadership reporting.
Prepare clear, concise compliance updates and risk assessments for executive leadership and, as needed, the Board.
Maintain documentation and audit trails sufficient to demonstrate compliance readiness at all times.
Cross-Functional Partnership
Advise Product and Actuarial teams early in product design on regulatory feasibility across current and target states.
Train and support Claims, Member Services, and Sales teams on regulatory requirements affecting their day-to-day work (e.g., prompt pay standards, appeals timelines, marketing compliance).
Act as an internal consultant, helping non-compliance teams understand "what's required and why" without becoming a bottleneck.

Required Qualifications

Bachelor's degree required; JD, MBA, or relevant advanced degree a plus but not required.
Must be familiar with health insurance regulatory reporting requirements such as Mental Health Parity, Prompt Pay, Market Conduct, Gold Card, Balance Billing, and Network Adequacy.
8+ years of progressive experience in health insurance regulatory compliance, with direct experience at a fully insured commercial health carrier (HMO, PPO, or indemnity).
Demonstrated hands-on experience with state DOI rate/form filings and SERFF.
Experience supporting or leading multi-state licensing and market entry for an insurance carrier.
Strong working knowledge of state insurance codes, NAIC model laws/regulations, and federal requirements applicable to fully insured group and individual health coverage (ACA market reforms, HIPAA administrative simplification, COBRA/ERISA as applicable to fully insured plans).
Experience managing or responding to regulatory examinations and market conduct exams.
Excellent written and verbal communication skills, with the ability to translate complex regulatory requirements into practical business guidance for non-compliance audiences.
Highly organized, self-directed, and comfortable operating with significant ownership in a lean, fast-moving organization.
Excellent time management and organizational skills required to maintain the reporting calendar and state points of contact.

Preferred Qualifications

Experience specifically expanding a Texas-domiciled or Texas-licensed carrier into additional states.
Familiarity with Texas Department of Insurance requirements and relationships within the TDI.
Experience building a compliance function from an early stage (vs. only operating within an established, mature program).
Working knowledge of health plan network adequacy and provider contracting compliance requirements.
Professional certification such as CHC (Certified in Healthcare Compliance), CPCU, HIA, or AHIP fully insured/HMO designations.
Experience with fully insured group employer products specifically (as opposed to Medicare Advantage, Medicaid, or self-funded/ASO business), given Evry Health's current product mix.
Favorable consideration given to candidates who can also assist with Enterprise Risk Management (ERM) and ORSA-related risk management reporting.

What Success Looks Like in the First Year

New-state licensing and filing playbook established and successfully executed for at least one expansion state.
A documented, board-visible compliance program (policies, monitoring calendar, risk reporting cadence) is in place.
Strong, responsive working relationships established with the Texas DOI and any newly entered state DOIs.
Cross-functional teams (Product, Claims, Sales) have clear, practical guidance on regulatory requirements relevant to their work.

Telecommuting Requirements

This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
Must live in the United States within the CST or EST time zones.
Company business hours are weekdays 9-5 CST.
Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
Ability to keep all company sensitive documents secure.
Must live in a location that receives an existing high-speed internet connection/service.

Originally posted on Himalayas