SUBJECT MATTER EXPERT

Federally Facilitated Exchange Oversight Subject Matter ExpertFederally Facilitated Exchange (FFE) oversight programs ensure the federal health insurance marketplace (HealthCare.gov) runs properly and follows the Affordable Care Act. Oversight activities can involve: Analyzing data and conducting audits to maintain marketplace integrity; identifying any problemstechnical, regulatory, or accuracy-related. Enforcing agent and broker activities such as registration, licensing, and consumer enrollment. Reviewing and responding to agent and broker inquiries to guide compliance actions. Assessing Enhanced Direct Enrollment (EDE) entities' compliance with program requirements. Role: We are seeking a knowledgeable and experienced Subject Matter Expert (SME) to support the operational, regulatory, and compliance functions of the FFE. This role supports oversight activities for health insurance issuers, web-brokers, agents/brokers, and Direct Enrollment (DE/EDE) entities participating in the Health Insurance Marketplace. The SME provides high-level expertise in ACA Marketplace policy, issuer compliance, audit support, data interpretation, and operational guidance. This position is ideal for an experienced professional with deep understanding of Exchange operations and federal oversight requirements. Responsibilities: Serve as the lead expert on Affordable Care Act (ACA) Marketplace requirements, including QHP issuer rules, broker/web-broker participation standards, and FFE operational processes. Provide guidance on compliance oversight, corrective action planning, enforcement processes, and program integrity activities. Support Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) program operations, including audit requirements, readiness reviews, privacy standards, and website/eligibility process evaluations. Interpret complex regulatory and operational guidance and translate requirements into actionable recommendations for project teams and stakeholders. Contribute expert insights to data analysis activities, issuer performance monitoring, risk assessments, and compliance trend evaluation. Review and refine operational policies, SOPs, training materials, technical guidance, templates, and other program documents. Participate in stakeholder engagements, including collaboration with internal CMS teams, state regulators, and external partners. Assist in preparing training, briefings, and communications to support program operations and compliance understanding. Ensure all recommendations and materials align with federal security, privacy, and data-handling standards. Requirements: Significant state regulatory experience, preferably in the field of insurance; Ability to lead the communications with State DOIs and issuers; Knowledge of the insurance industry, preferably the health insurance industry; Experience: At least 5 years of experience related to areas noted above, or a combination of education and equivalent work experience; Education: A Master's degree in public policy, information management, statistics, business, or related fields or equivalent combination of education and experience. EOE STATEMENT: Healthcare Management Solutions, LLC has established an Affirmative Action Plan. HMS is deeply committed to the concept and practices associated with equal opportunity and affirmative action in all aspects of employment. HMS makes clear that all applicants will be treated without regard to race, color, sex, religion, national origin, age, disability, genetic information, sexual orientation, ancestry, marital status, changes in marital status, pregnancy or parenthood, gender, or gender identity or expression, military or veteran status, political affiliation, or any other protected characteristics under applicable law when the reasonable demands of the position(s) do not require distinction on the basis of age, disability, sex, marital status, changes in marital status, pregnancy, or parenthood. This company does not tolerate unlawful discrimination in its employment practices. We recognize the value of diversity in our workforce and encourage all qualified candidates to apply. We thank all candidates who choose to apply, however, only those selected for a further interview will be contacted. Equal Opportunity Employer/M/F/Vet/Disabled