Assistant General Counsel for Health Plan Operations

Accountabilities Provide practical legal counsel across health plan operations, including claims administration, payment integrity, appeals, and related regulatory requirements.

Advise network development and management teams on provider contracting, provider relationships, credentialing, and operational legal matters.

Partner with compliance teams to support adherence to state and federal healthcare laws, regulations, and health plan requirements.

Provide legal guidance on delegated arrangements involving third-party administrators, pharmacy benefit managers, behavioral health providers, and other external partners.

Support delegated entity oversight programs, including compliance monitoring, remediation efforts, and regulatory reporting obligations.

Monitor evolving healthcare regulations and translate complex legal requirements into actionable recommendations for operational and clinical teams.

Assist with regulatory examinations, audits, inquiries, and interactions with state insurance departments and other regulatory agencies.

Advise on the legally compliant implementation of clinical programs, quality initiatives, utilization management processes, and strategic business decisions.

Build strong relationships with internal stakeholders and provide solutions-oriented guidance on complex legal and operational matters.

Requirements

Active license to practice law in at least one U.S. state.

8-10 years of legal experience, including 2-4 years of in-house counsel experience.

Prior experience working within a health plan environment is required.

Strong knowledge of healthcare regulatory requirements related to health plan operations, including claims, provider contracting, delegation, delegated entity oversight, and applicable state and federal regulations.

Ability to analyze legal issues through a business-focused lens and provide practical, actionable recommendations.

Proven ability to manage complex legal matters, meet regulatory deadlines, anticipate risks, and develop effective solutions.

Excellent communication, collaboration, and relationship-building skills with the ability to work across multiple departments.

Proactive and adaptable mindset with the ability to operate effectively in a fast-changing environment.

Strong organizational skills and the ability to manage multiple priorities while maintaining attention to detail and urgency.

High level of professionalism, integrity, curiosity, and commitment to continuous growth.

Experience supporting Medicare Advantage plans is highly desirable.

Benefits

Fully remote position available across the United States.

Competitive annual salary range of $175,000 - $225,000 , plus equity opportunities.

Employer-sponsored medical, dental, and vision plans with low or no employee premiums.

Stock options available for employees.

Bonus eligibility for applicable roles.

Generous paid time off program.

Paid parental leave benefits.

401(k) retirement savings program.

$100 monthly mobile or internet stipend.

Opportunity to work on meaningful healthcare initiatives that improve patient and member experiences.

Collaborative environment focused on innovation, professional growth, and mission-driven work.

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