Director, Policy and Research We are seeking a Director in our Policy and Research department to support policy, as well as legislative and regulatory analysis, for the commercial health insurance market. The individual will be responsible for supporting the policy development and response to current and emerging public policy issues on coverage across the commercial health insurance markets including insurer and pharmacy benefit manager (PBM) actions.
Tasks will include:
Serving as a subject matter expert on public policy matters affecting the commercial health insurance markets with a focus on insurer, health plan, and PBM actions affecting patient coverage and access. Provide expertise on policies related to commercial coverage regulation and oversight including in the Employee Retirement Income Security Act (ERISA) and the Affordable Care Act (ACA) as well as understand different aspects of regulation in these markets such as health maintenance organizations (HMOs), flexible spending accounts (FSAs), medical loss ratio (MLR), and Individual Coverage Health Reimbursement Arrangements (ICHRA).Provide expertise on issues related to vertical integration of healthcare companies. Understand insurer, PBM, and employer implemented copay adjustment programs such as accumulator adjustment programs, copay maximizer programs, and alternative funding programs (AFPs).Analyze trends, research studies, and third-party policy analyses relating to employer-based coverage and individual and small group insurance markets. Analyze federal regulations and other guidance from the Departments of Health and Human Services, Labor, and the Treasury and guide development of comment letters through established work group processes and engaging outside consultants as necessary and appropriate. Lead the development of up-to-date talking points and materials in support of federal and state advocacy efforts on commercial health insurance coverage, including individual and small group markets, employer-sponsored insurance, and Health Insurance Marketplaces. Analyze proposed legislation to identify key areas of interest for the members and coordinate with the Law department and others on potential amendments and legislative alternatives. Prepare and deliver presentations on priorities to groups external and internal to the company and lead the development of slide decks, talking points, and other relevant materials. Support the organization's advocacy and third-party engagement with employer, insurance, and patient advocacy groups. Identify gaps in existing research and analysis and recommend action to fill the gaps, working in concert with the Policy and Research team. Manage day-to-day interactions with external consultants on assigned department-initiated projects. Perform other duties as assigned. Key Success Factors We are looking for a collaborative, proactive, self-starter who is passionate about access to medicines and contributing to the healthcare challenges we face today. Key success factors for this role include strong interpersonal skills and team focus paired with the ability to work and prioritize tasks independently. The candidate will bring substantive health policy analysis experience, particularly regarding individual- and employer-based health insurance, as well as exceptional written and verbal communication skills. The candidate should have demonstrated expertise in designing, reviewing, and interpreting in-depth policy analyses to support public policy advocacy. Lastly, the candidate should be focused, organized, detail-oriented, responsive, and diplomatic. Professional Experience / Requirements Bachelor's Degree required. 6+ years of experience in legislative or regulatory policy and/or advocacy. Strong writing that communicates clearly and persuasively on advocacy issues. Strong verbal communication and presentation skills. Ability to synthesize, distill and clearly communicate complex ideas to a non-technical audience. Be an adaptable, creative problem solver, who is comfortable working in a high-pressure environment. Excellent interpersonal skills that foster the ability to design and manage multiple projects simultaneously. Preferred Experience / Requirements A Master's degree in public policy or related field; Prior experience working on Capitol Hill, or at HHS, a state legislative body, state regulatory agency, PBM, health insurance company, drug manufacturer, or health care trade association or consultancy; and Experience developing and achieving public policy objectives in one or more of the following areas: ERISA, ACA, Health Insurance Marketplaces, or state-regulated individual and group health insurance.
