This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Assistant General Counsel for Health Plan Operations based in the United States.
This is a unique opportunity for an experienced healthcare attorney to provide strategic legal guidance supporting complex health plan operations and business initiatives. In this role, you will serve as a trusted advisor to operational, clinical, and business teams, helping navigate evolving healthcare regulations while enabling efficient and compliant solutions. You will contribute directly to critical areas including claims, provider networks, contracting, delegated entity oversight, and regulatory compliance. Working in a fast-paced and collaborative environment, you will combine legal expertise with business judgment to solve complex challenges and drive meaningful improvements in healthcare delivery. This position offers significant ownership, visibility, and the opportunity to make a lasting impact within a growing healthcare organization.
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.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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