Director of Regulatory Compliance- Large Group Health Insurance

Position Summary

Evry Health is a large group health insurance carrier seeking a Director of Regulatory Compliance to build, own, and scale the company's regulatory compliance function during a pivotal period of multi-state expansion. This is a hands-on, individual-contributor-to-builder role: the Director will serve as the company's primary subject-matter expert on state Department of Insurance (DOI) requirements, filing obligations, and licensing, while establishing the compliance infrastructure, policies, and monitoring processes needed to support new-state entry and ongoing operations as a fully insured carrier.

This role will work cross-functionally with Actuarial, Legal, Product, Claims, Network/Provider Relations, and Sales to ensure that Evry Health 's products, operations, and market conduct meet all applicable state and federal insurance regulatory requirements — today in Texas, and in each new state as it comes online.

This is a foundational hire. The successful candidate will have the opportunity to shape Evry Health 's compliance program from an early stage rather than inherit a mature, heavily bureaucratic function.

Key Responsibilities

Multi-State Expansion & Licensing

- Lead the regulatory workstream for entry into new states, including certificate of authority applications, insurer licensing, foreign qualification coordination, and producer/agency licensing requirements.

- Research and map state-specific insurance regulatory requirements (mandated benefits, network adequacy, prompt pay, grievance/appeals, rate and form filing) to inform go/no-go and sequencing decisions for expansion states.

- Build a repeatable "new state playbook" that captures licensing steps, filing timelines, and ongoing obligations so future state launches become faster and lower-risk.

Filings & Regulatory Submissions

- Own or closely partner with Actuarial on SERFF (System for Electronic Rate and Form Filing) submissions for rate and form filings, ensuring accuracy, completeness, and timely response to DOI objections.

- Track and manage all state filing deadlines, renewals, and required periodic reporting (financial, market conduct, statistical, network adequacy, etc.).

- Maintain a master compliance calendar and filing tracker across all states of operation.

- Assist the CFO and Chief Actuary in maintaining the financial reporting calendar (this position is not responsible for financial submissions).

Regulatory Relations

- Serve as the primary point of contact with the Texas Department of Insurance and, as applicable, other state DOIs, NAIC, and CMS on matters not involving Medicaid/Medicare (e.g., ACA market reforms, exchange requirements if applicable).

- Manage regulatory examinations, market conduct exams, inquiries, and complaint escalations; coordinate responses across departments.

- Monitor legislative and regulatory developments (state and federal, including ACA/ERISA where relevant to fully insured group business) and translate changes into actionable business impact assessments.

Compliance Program & Policy Development

- Design, implement, and maintain Evry Health 's compliance policies, procedures, and internal controls (e.g., complaint handling, prompt pay, appeals/grievances, producer oversight, advertising/marketing review, privacy practices coordination with HIPAA compliance).

- Establish a compliance monitoring and testing program to proactively identify and remediate gaps ahead of exams or audits.

- Partner with Legal and HR to ensure producer/agent appointment, licensing, and training requirements are met in all operating states.

Risk Management & Reporting

- Support the Chief Actuary in enterprise risk management activities related to regulatory and compliance risk, including input into ORSA-related processes, risk registers, and board/leadership reporting.

- Prepare clear, concise compliance updates and risk assessments for executive leadership and, as needed, the Board.

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