Description:
Reporting to the General Counsel, the Healthcare Product and Regulatory Attorney will provide strategic legal and compliance advice across Gravie’s product portfolio, including level-funded group health plans and ICHRA individual marketplace solutions.
You Will
Regulatory Analysis and Guidance
- Provide timely, accurate, and practical legal advice on complex state and federal healthcare laws and regulations impacting Gravie’s health plan operations, benefit offerings, and business activities. This includes, but is not limited to, HIPAA, ERISA, ACA, COBRA, surprise billing laws (No Surprises Act), transparency laws, mental health parity (MHPAEA), and state insurance regulations.
- Monitor and analyze new legislative, regulatory, and sub-regulatory guidance from relevant federal (e.g., HHS, DOL, IRS) and state agencies.
- Translate complex regulatory requirements into clear, actionable advice for product, operations, sales, and executive teams.
- Support compliance efforts related to licensing, market conduct, and state-specific mandates for health plan products.
Health Plan Operations and Benefit Design Support
- Review and advise on health plan documents, including Summary Plan Descriptions (SPDs), Certificates of Coverage (COCs), plan amendments, member contracts, and related materials to ensure regulatory compliance.
- Provide regulatory input on benefit structure, coverage limitations, medical management programs (e.g., prior authorization, utilization review), and appeals processes.
- Collaborate with the Operations team on compliance issues related to claims processing, eligibility, enrollment, and member services.
- Assist in the legal review of marketing materials and member communications related to health plan benefits.
Product Development and Strategy
- Serve as a key legal advisor on the development and launch of new health plan products and features.
- Identify and mitigate regulatory risks associated with new initiatives and market expansions.
- Collaborate with product and engineering teams to ensure compliance is built into the product design from the outset.
General Legal Support
- Assist in responding to regulatory inquiries, examinations, and investigations.
- Develop and deliver internal training on relevant legal and regulatory topics.
- Manage outside counsel relationships as needed for specialized regulatory matters.
You Bring
- Juris Doctor (J.D.) degree from an accredited law school.
- Active membership in good standing of at least one state bar (and eligible to register as in-house counsel, if applicable).
- 5+ years of experience practicing law, with significant experience advising clients on health plan regulatory matters (in-house health plan experience, government experience, or experience at a law firm serving health plan clients preferred).
- Deep knowledge of federal laws governing health plans, including ERISA, ACA, HIPAA (including privacy, security, and transactions), No Surprises Act, and MHPAEA.
- Familiarity with state insurance laws and regulations applicable to fully insured and/or self-funded health plans.
- Excellent written and verbal communication skills, with the ability to clearly and concisely explain complex legal issues to non-lawyers.
- Strong analytical, problem-solving, and decision-making skills.
- Ability to work independently, manage multiple priorities in a fast-paced environment, and meet deadlines.
- High level of professionalism, integrity, and ethical conduct.