Director of Regulatory Compliance- Large Group Health Insurance
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AI Summary
The Director of Regulatory Compliance will build and scale the company's compliance infrastructure to support multi-state expansion and ongoing operations. They will serve as the primary subject-matter expert for state insurance filings, licensing, and regulatory relations while managing internal policies and risk assessments.
Position Summary
Evry Health is a large group health insurance carrier seeking a Director of Regulatory Compliance to build, own, and scale the company's regulatory compliance function during a pivotal period of multi-state expansion. This is a hands-on, individual-contributor-to-builder role: the Director will serve as the company's primary subject-matter expert on state Department of Insurance (DOI) requirements, filing obligations, and licensing, while establishing the compliance infrastructure, policies, and monitoring processes needed to support new-state entry and ongoing operations as a fully insured carrier.
This role will work cross-functionally with Actuarial, Legal, Product, Claims, Network/Provider Relations, and Sales to ensure that Evry Health's products, operations, and market conduct meet all applicable state and federal insurance regulatory requirements — today in Texas, and in each new state as it comes online.
This is a foundational hire. The successful candidate will have the opportunity to shape Evry Health's compliance program from an early stage rather than inherit a mature, heavily bureaucratic function.
\nMulti-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.
- 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.
- 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.
- 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.
- 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.
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