We are recruiting for a mission-driven Health Plan Products Analyst (Commercial/Exchange) - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.) to join our team! We're with you for life’s journey.
At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration * Must live in Colorado * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week. Job Summary The Analyst, under general supervision, assists in developing Denver Health Medical Plan, Inc.
(DHMP) Health Plan Products to ensure compliance with all Federal and State–level regulatory requirements. This position requires strong attention to detail and the ability to independently research, interpret, and apply regulatory guidance to support compliance activities and business operations. The Analyst leads and provides expert technical assistance to highly visible, sensitive, and multifaceted compliance initiatives.
Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of issues. Prepares monthly reports, develops marketing materials, policies, and procedures for each line of business. This position will interact with all levels of management and employees, plan members, external consultants and Federal and State representatives.
The Analyst works collaboratively, fosters and promotes dialogue with CMS Regional Office, State Agencies, and Community Partners.
Compliance Compiles, analyses and ensures the accuracy of data and documentation for internal and external compliance audits. Creates and monitors marketing materials and content to meet State and Federal regulatory requirements, including member handbooks/Explanation of Coverage, notifications regarding enrollment, beneficiary rights and protections, and other mandated communications. (25%) Strategy and Planning Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of issues.
(20%) Policy and Procedure Develops and drafts policies and procedures in alignment with State and Federal Requirements, ensures operationalization of policies and procedures. Identifies problems and opportunities for improvement; works collaboratively to identify solutions (20%) Reporting and Analysis Compiles reports, attestations, and other submissions to submit to the State and Federal agencies. Reconciles complex sets of data received from State and Federal Regulators in order to validate reporting, financial reconciliation, and encounter submissions to align with established goals and metrics.
(15%) Vendor Management Monitors external vendors or first tier entities that administer benefits for members, analyzing data to ensure compliance with contractual requirements (10%) Serves as Liaison between Product Lines and other areas of the Managed Care Department, to interpret contractual and regulatory requirements that may assist with provider, member or other operational concerns. (10%)
Bachelor's Degree required Work
1-3 years direct health care experience with a specific emphasis on government health program operations, commercial health plan operations, regulatory issues, policy development, or compliance required Licenses : Knowledge, Skills and Abilities : Extensive knowledge of managed care/health care administration, policy and compliance. Proven ability to interpret and synthesize Federal and State regulatory requirements, ensuring policies, procedures and processes are updated to comply with guidelines.
Ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends. Ability to define problems, collect data, establish facts and draw valid conclusions to implement solutions. Demonstrates ability to manage multifaceted projects in conjunction with day-to-day activities.
Excellent interpersonal and customer service skills, ability to work collaboratively with other corporate groups (such as Compliance Department, and Information Systems), external vendors and State and Federal entities. Self-motivated and takes initiative: identifies, acts on, and documents solutions for gaps and opportunities for process improvements. Critical thinking, strong written and verbal communication skills, and the ability to effectively interact within a team.
Assists in monitoring of risk assessments, preparation and compilation of audit requirements interprets audit results; monitors daily, weekly and monthly reports. Proficiency in Health Plan Management Software involving Claims, Enrollment systems, and Government Data Portals. Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn computer applications. * Must live in Colorado * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.
Shift Days Work Type Regular Salary $65,600.00 - $98,400.00 / yr Benefits At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions.
When you join Denver Health, you’re joining a mission-driven organization that invests in you. Here is a small list of our benefit programs: Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays 100% paid parental leave up to 6 weeks Immediate eligibility for retirement plans with employer contribution up to 9.5% Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center Free RTD EcoPass (public transportation) Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer About Denver Health Denver Health is an integrated, high-quality academic healthcare system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.
As Colorado’s primary, and essential, safety-net healthcare system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE).
We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.