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Years of Experience
Date Last Verified
Director & Assistant General Counsel Duties: Provides a full range of legal services to the company including management of the day to day operations of the Legal Department. Assumes overall responsibility for the Complaints and Appeals Department. Synthesize complex legal requirements and numerous operational details to ensure legal compliance and minimize risk. Expected to use a broad range of legal expertise and analysis, and general business knowledge of HNE to render independent decisions affecting company strategy, tactics and operations. Participate on numerous committees and projects within HNE and serve as member of the Director’s team. Saves the company millions of dollars by working to prevent costly expenditures on legal actions such as law suits, settlements, and administrative fines. Provides hands-on expert legal counsel to all HNE departments and manages the operations of the Legal Department including Complaints & Appeals. Provide both legal advice and general business support as a member of the Director’s team. Proactively updates management on any relevant legislative updates, and/or changes to current legislation Develops goals, objectives, policies and procedures applicable to the duties and responsibilities of the department. In consultation with the VP/General Counsel exercises decision-making authority for the department and ensures department resources are applied properly. Coordinate with the Director of Compliance and Compliance Committee to ensure that changes required by various government agencies are implemented by the appropriate HNE departments. Provide legal services and advice to management on a broad spectrum of issues affecting company operations. Remain current on all new laws and regulations that affect HNE as a company. Assist departments in adjusting processes and procedures to comply with changes in the law and in responding to member, provider and employer inquiries. Working with the Director of Compliance, review, and, as needed, prepare or conduct training for individual departments or the company as a whole with regard to laws or regulations that affect them. Participate in HNE projects and initiatives as both a lawyer and key manager. Participate in HNE projects and initiatives as a contributor to successful team results. Work with other managers on company-wide projects that support the company’s goals and initiatives. Develop, as part of the project team, sound policies and strategies that meet legal requirements as well as business needs. Draft, or review and revise, contracts between Health New England and various vendors and consultants, and review and revise member documents and agreements. Draft, or review and revise, contracts between Health New England and various vendors and consultants, including: Understand the terms of the deal that is to be represented in the contract. Negotiate with counsel for the counterparty as needed. Assist other HNE staff in interpreting and applying applicable contract provisions. Working with the Marketing Department, review and revise Member Agreements (Explanations of Coverage and Summary Plan Descriptions) and other member documents (e.g., summaries of benefits) so that the documents comply with all legal requirements with regard to content, benefit plan design, drafting of document, and distribution to members. Manage litigation and potential litigation and related tasks. Work with outside litigation counsel to determine case strategy. Ensure that legal fees do not exceed budgeted amounts. Review and, if necessary, revise all materials prepared by outside counsel to ensure quality and accuracy. Coordinate HNE’s responses to discovery requests and document subpoenas. Attend depositions when necessary. Work with HNE managers who have been subpoenaed to testify to prepare them for testimony. Research relevant law involved in litigation to ensure that HNE management is sufficiently apprised of legal risks. Work with insurance company to obtain coverage when available. Recommend reasonable settlement amounts to Senior Management when appropriate. Determine the company’s position in response to 93A letters and Division of Insurance investigations/inquiries and respond. Make sure that any settlements are communicated to appropriate persons in the company and implemented. Assist VP and General Counsel in various other litigation-related tasks. Act as liaison to state and federal government agencies. Act as a liaison to various state and federal government agencies including the Division of Insurance, Attorney General’s Office, office of Patient Protection, Department of Health and Human Services, etc. Respond to the agencies’ questions and concerns regarding various filings, HNE compliance with regulatory provisions, etc. Negotiate compromises, settlement agreements, product changes, etc. with the agencies as necessary.
Qualification and Experience
Requirements: JD Degree and 5+ years of legal experience in a law firm, government agency, or corporate legal department; experience working within the managed care or insurance industry is a plus. License to practice in Massachusetts. Knowledge of managed care, health care, corporate and employment law. Knowledge of recent legislative and case law developments. Excellent research, writing and communication skills. Excellent problem solving skills. Ability to apply legal rules to daily operations pragmatically, with attention to both good legal analysis and good business sense. Ability to present an unpopular opinion. Ability to work independently or as a team member. Ability to advocate to executive management and others the necessity of accepting stringent and unpleasant legal requirements. Ability to act proactively to identify and correct company policies that could result in liability. Ability to work well with both internal and external customers. Ability to prioritize assignments. Ability to lead teams. Excellent word processing skills .
Job Req #: R018-18
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