Washington State Office of the Insurance Commissioner · 16 hours ago
Functional Program Analyst 3 – HCBM Analyst
Olympia, WA
Full-time
Hybrid
Senior Level
$5,137/mo - $6,906/mo
6+ years expThe Washington State Office of the Insurance Commissioner (OIC) is seeking a qualified individual for the Functional Program Analyst 3 – HCBM Analyst position within the Rates, Forms, and Provider Networks Division. This role involves analyzing Health Care Benefit Manager contracts to ensure compliance with state and federal laws, thereby protecting consumers and ensuring the integrity of the insurance system.
GovernmentInsuranceQuality Assurance
Responsibilities
Independently analyze and evaluate Health Care Benefit Manager (HCBM), health carrier, provider, pharmacy, and related contract forms to ensure compliance with Washington State insurance laws, regulations, applicable case law, and federal requirements
Review complex contractual documents, including Statements of Work, Business Associate Agreements, base contracts, templates, and amendments, to assess whether legal and regulatory standards are met
Interpret and assess contract provisions governing prior authorization, medical necessity determinations, utilization review, claims processing, provider credentialing, payment methodologies, dispute resolution, appeals, provider network management, and disease or care management activities
Identify compliance issues, deficiencies, or areas of concern and develop clear, well-reasoned recommendations for corrective contract language or action
Apply and interpret relevant RCWs, WACs, and case law to support consistent, legally sound contract reviews and regulatory decisions
Communicate compliance concerns, review findings, and required revisions to health carriers, HCBMs, and third-party filers in a professional, clear, and solution-oriented manner
Collaborate with the Functional Program Analyst 4 Supervisor, Program Manager, and OIC colleagues to discuss significant issues, ensure consistency in review standards, and address matters that may impact the broader insurance marketplace
Conduct research and provide subject-matter guidance to internal staff and external stakeholders regarding HCBM contracts, regulatory requirements, and compliance expectations
Support the OIC’s consumer protection mission by helping ensure that regulated entities issue contracts that are fair, transparent, and compliant before entering the marketplace
Qualification
Required
Six (6) years of professional work experience in areas such as contract management, drafting and/or review of legal documents; regulatory examinations, regulatory compliance, claims; or health care benefit plan design, distribution, or administration
A degree in public administration, business administration, law/legal studies, finance or related field from an accredited institution whose accreditation is recognized by the U.S. Department of Education or the Council of Higher Education Accreditation, or a foreign equivalent may be substituted for relevant experience. Proof of degree may be required prior to employment. If a degree was awarded outside of the United States, candidates must provide a credential evaluation report
Intermediate-level skills in Microsoft Outlook, Word, and Excel
Preferred
Advanced skills and experience in Microsoft Outlook, Excel, and Word
Demonstrated experience organizing work, establishing timelines, and meeting deadlines
Benefits
Comprehensive benefits package: Health, dental, vision, retirement, paid leave (vacation, sick, etc.) and much more!
Supportive work environment: We value diversity, professional growth, and collaborative atmosphere.
Wellness programs: Invest in your well-being with on-site resources and initiatives.
Work-life balance: Flexible schedules with telework opportunities.
Public service fulfillment: Contribute to a cause that matters and feel the satisfaction of serving the public good.
Training & Development: Continuously learn and grow with tuition reimbursement, Public Service Loan Forgiveness, and other programs.
Free parking (Tumwater) & Public transportation pass (Thurston County): Save on commuting costs.
Company
Washington State Office of the Insurance Commissioner
The Washington state Office of the Insurance Commissioner, led by Commissioner Patty Kuderer, protects insurance consumers.
201-500 employees
Funding
Current Stage
Growth StageRecent News
2021-12-29
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