Issuer Operations Manager - State Based Exchange
- 💼
- Insurance and Safety Fire Commissioner, Office of - OCI
- 📅
- May 28, 2025 Post Date
Under limited supervision, the Issuer Operations Manager develops skills and provides focus on the market conditions/changes in Georgia and nationally related to the individual and small group health insurance marketplace.
Develops the annual certification criteria, application instructions and submission timeline for Georgia marketplace medical and dental plans.
Conducts plan certification activities, working agency departmental staff and external examiners to support health insurance carriers in addressing corrections needed to their medical and dental plan applications and managing updates to policies and processes, as needed.
Liaises with the Center for Consumer Information and Insurance Oversight (CCIIO) and maintain knowledge of federal guidelines to ensure compliance of medical and dental plans offered on Georgia Access.
Reviews and interprets annual updates to federal guidelines in the Notice of Benefit and Payment Parameters (NBPP) to support evaluating impacts to Georgia Access and implementing any required or desired changes.
Manages the Georgia Access Small Business Health Options Program, including employer applications, employer eligibility determinations, employer appeals, and carrier reporting.
Develops and implements the Exchange’s healthcare access strategy to regulate and analyze health insurance carrier compliance with network adequacy standards in support of annual Quality Health Plan (QHP) review and certification.
Oversees plan management activities in the Georgia Access Eligibility and Enrollment System, including plan data verification, public use file (PUF) generation and posting, and plan data change management post-open enrollment.
Manages day-to-day health insurance carrier operations related to plan offerings and provide support on issue escalations.
Supports Georgia Access and health insurance carriers’ preparedness for annual Open Enrollment.
Maintains strong relationships with health insurance carriers and serve as the primary point of contact for Georgia Access.
Performs other duties as assigned.
