Assistant General Counsel for Health Plan Operations

Role Overview

This opportunity is offered through a partner organization seeking an experienced healthcare attorney to provide strategic legal support for intricate health plan operations and associated business initiatives across the United States. The Assistant General Counsel will act as a key advisor to operational, clinical, and business teams, guiding them through the complexities of healthcare regulations while enabling compliant and efficient solutions. The work includes handling critical aspects such as claims, provider networks, contracting, oversight of delegated entities, and ensuring regulatory compliance in a dynamic, collaborative environment.

Key Responsibilities

• Deliver practical and actionable legal advice encompassing claims administration, payment integrity, appeals, and applicable regulatory mandates within health plan operations.
• Advise teams overseeing network development, including matters related to provider contracting, relationships, credentialing, and legal operational concerns.
• Collaborate with compliance departments to ensure adherence to pertinent state and federal healthcare laws, regulations, and specific health plan standards.
• Provide legal oversight and guidance for delegated arrangements involving third-party administrators, pharmacy benefit managers, behavioral health providers, and other external partners.
• Support delegated entity oversight efforts by facilitating compliance monitoring, remediation procedures, and regulatory reporting obligations.
• Keep abreast of evolving healthcare legislation and translate these complex legal requirements into clear, actionable guidance for operational and clinical teams.
• Assist in managing regulatory examinations, audits, inquiries, and interactions with insurance departments and regulatory authorities.
• Advise on compliant implementation of clinical programs, quality initiatives, utilization management processes, and strategic decisions impacting the business.
• Establish and maintain strong working relationships with internal stakeholders, offering solutions-oriented advice related to complex legal and operational challenges.

Candidate Requirements

• Must hold an active license to practice law in at least one U.S. state.
• Possess 8 to 10 years of legal experience, including 2 to 4 years serving as in-house counsel.
• Prior experience within a health plan environment is mandatory.
• Deep understanding of healthcare regulatory frameworks related to health plan operations such as claims, provider contracting, delegation, oversight of delegated entities, and relevant state and federal rules.
• Strong capacity to evaluate legal matters with a practical business-oriented approach and offer clear, implementable advice.
• Proven track record managing complex legal issues, adhering to regulatory timelines, anticipating risks, and crafting effective solutions.
• Excellent communication, teamwork, and relationship-building abilities, capable of collaborating across diverse departments.
• Adaptable and proactive mindset suited for fast-paced and changing situations.
• Exceptional organizational skills with an ability to juggle multiple tasks without compromising detail or urgency.
• High standard of professionalism, integrity, intellectual curiosity, and dedication to ongoing professional development.
• Experience with Medicare Advantage plans is highly desirable.

Compensation and Benefits

• This is a fully remote position, available throughout the United States.
• Competitive annual salary ranging from $175,000 to $225,000 complemented by equity participation options.
• Comprehensive employer-sponsored medical, dental, and vision insurance with minimal or no employee premiums.
• Employee stock option program.
• Eligibility for performance bonuses where applicable.
• Generous paid time off policy.
• Parental leave benefits.
• 401(k) retirement savings plan.
• $100 monthly stipend for mobile or internet expenses.
• Engagement in meaningful healthcare projects aimed at enhancing patient and member experiences.
• A collaborative work environment promoting innovation, professional growth, and mission-driven goals.

Additional Information

The position is managed by a partner company responsible for application review and further recruitment steps. The hiring decision and subsequent processes such as interviews and assessments are carried out directly by the partner organization's internal team.

Applicants should be aware that personal data is processed in compliance with relevant data protection regulations to assess candidacy, facilitated partly by AI tools for resume analysis and application review. However, final hiring decisions remain the responsibility of human recruiters.