Marketplace Plan Management & Certification Policy Analyst

Position Overview

This opportunity as the Policy Analyst for Plan Management & Certification for the Illinois State Based Marketplace is both exciting and impactful. You'll play a vital role in assisting consumers and will be responsible for 1095 enrollment data services and information about health plans that are to be displayed on the Get Covered Illinois (GCI) Marketplace. 1095 Enrollment Data Services encompasses a high profile set of critical GCI functions, including monthly and annual enrollment/data submission to the Internal Revenue Service as well as the annual production of 1095A tax forms for consumers. This position will also be involved with regulatory certification of Qualified Health Plans (QHPs) and Qualified Dental Plans (QDPs), plan data structure filing requirements and reconciliation efforts around the health plan data received from health insurance companies offering products on the marketplace. As the lead around 1095 data services, you'll have the chance to shape the initial phases of the Marketplace rollout, setting the foundation for long-term success. By leveraging your expertise and leadership, you'll contribute to the seamless functioning of the Marketplace and positively impact the lives of Illinois residents for years to come. We encourage all qualified applicants to apply and be part of this exciting opportunity to make a difference in healthcare accessibility in Illinois. If you have the skills, passion, and commitment to drive this initiative forward, we look forward to receiving your application.

Get Covered Illinois is the State of Illinois’s new Health Insurance Marketplace. Get Covered Illinois’s mission is to increase access, enrollment, affordability, and choice for individuals and families by connecting them to health insurance plans and savings available through the Affordable Care Act. Get Covered Illinois provides pathways to coverage through a consumer-centric online application platform, a Customer Assistance Center, localized outreach and education strategies and a network of in-person assisters embedded in communities across the state that help Illinoisans enroll in the coverage that best meets their families’ needs. Get Covered Illinois is part of the Illinois Department of Insurance and has offices in Chicago and Springfield.

Why Work for Illinois?

Working with the State of Illinois is a testament to the values of compassion, equity, and dedication that define our state. Whether you’re helping to improve schools, protect our natural resources, or support families in need, you’re part of something bigger—something that touches the lives of every person who calls Illinois home.

No matter what state career you’re looking for, we offer jobs that fit your life and your schedule—flexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.

Essential Functions

• Under the direction of the Marketplace Plan Management and Carrier Relations Director, serves as the statewide Marketplace Plan Management & Certification Policy Analyst for the Division of State Based Marketplace: utilizes in-depth knowledge and understanding of the Patient Protection and Affordable Care Act (ACA), state regulations, rules, and health reform policy issues and associated federal regulations and guidance related to Get Covered Illinois (GCI) to engage in regular policy analysis that will drive operational decisions for implementation.
• Analyzes the implementation of business requirements to determine if they meet the business needs and regulatory requirements across all functional components of the GCI health insurance marketplace: works with the compliance area to help capture and track applicable state and federal requirements, adherence to GCI policies and priorities, identifies potential barriers, and ensure that strategies to address obstacles are developed and implemented.
• Under the direction of the Marketplace Plan Management and Carrier Relations Director, manages engagement with carriers on a variety of levels: develops and manages policies for carrier reconciliation process, including facilitating regular individual meetings with carriers to assist with reconciliation.
• Under the direction of the Marketplace Plan Management and Carrier Relations Director, manages the plan management processes, including the annual certification of Qualified Health Plans (QHPs) and Qualified Dental Plans (QDPs) offered through GCI in conjunction with state regulators at the Department of Insurance: follows federal and state statutory and regulatory requirements around QHP Certifications and how data must be used to comply with them. 
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

Minimum Qualifications

• Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college, preferably with courses in business or public administration.
• Requires two (2) years of responsible administrative experience in a public or business organization.

Preferred Qualifications

• Prefers at least two (2) years of experience working with health insurance policy analysis.
• Prefers at least four (4) years of professional experience related to operations and/or policy, preferably in health care, health insurance or a closely related industry.
• Prefers at least four (4) years of strong organization and project management skills and creativity. 
• Prefers at least four (4) years of engaging and building relationships with external stakeholders.  
• Prefers at least four (4) years of identifying, developing, and implementing operational solutions to unique issues, questions, and problems with little or no precedent. 
• Prefers at least four (4) years of conveying complex information and facilitating consensus in a positive and cooperative manner to achieve objectives. 
• Prefers a Master's Degree in Public Health, Public Administration, Business Administration, Public Policy, Juris Doctor (J.D.), or equivalent. 

Specialized Skills

• Of the two years of experience above, requires at least two (2) years of experience working with health insurance policy analysis.

Conditions of Employment

• Requires the ability to pass a background check.
• Requires ability to travel in the performance of duties, with overnight stays as appropriate.
• The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description.

About the Agency

The Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency. DOI has approximately 220 employees who are split between our Chicago and Springfield offices.

State of Illinois employees enjoy a robust benefit package, including:

• Health, Life, Vision, and Dental Insurance
• 13 Paid Holidays annually, 14 on even numbered years
• 10-25 days of Paid Vacation time annually - (10 days in year one of employment)
• 12 Paid Sick Days annually (sick days carry over from year to year)
• 12 Weeks Paid Maternity/Paternity Leave
• 3 Paid Personal Days annually
• Pension Plan
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• Flexible work schedules may be available, dependent upon position
• Tuition Reimbursement Program and Federal Public Service Loan Forgiveness Program eligibility

Visit https://www2.illinois.gov/cms/benefits/Pages/default.aspx for more information about our benefits.