Legal Counsel Sr.

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. The ideal candidate would reside in St. Louis, MO, Mason, OH, Indianapolis, IN or Louisville, KY. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law .

The Legal Counsel Sr. will help support the provider solutions team in California for insured, self-funded, and government business.

How you will make an impact:

• Provide legal guidance on a range of health law, regulatory, contractual and operational matters.

• Work as a strategic partner with assigned clients and provide legal advice and guidance on business strategies or various corporate initiatives; and assist with evaluating legal risks; propose alternatives to minimize risk where applicable.

• Proactively assist provider contracting staff with legal issues that arise during contract negotiations.

• Review proposed contract language changes; draft alternative language to protect the company's interests when needed.

• Support development and roll-out of new provider contract templates.

• Support provider disputes prior to litigation.

• Assist in early resolution of provider disputes to avoid litigation; interface with opposing counsel as needed.

• Assist with responding to regulatory inquiries or complaints.

• Support value-based contracting and negotiation of shared savings or risk arrangements.

• Utilize contract management software to facilitate tracking of custom provisions and documentation of required approvals.

• Review provider communications, including manuals, newsletters, and material change notices, to ensure compliance with legal and contractual requirements.

• Prepare settlement agreements, letters of intent, confidentiality agreements and other documents as needed.

• Reports on identified business exposure and associated risks to management as well as mitigation techniques being utilized.

• Works autonomously and manages work independently; Determines methods and procedures on new assignments and may coordinate legal projects with other legal colleagues or subject matter experts.

• Provide statutory/regulatory interpretation; review proposed legislation affecting the company's interactions with providers to identify implementation challenges and assist implementation team with interpretation of final bill language.

• Light travel may be required.

Minimum Requirements:

Requires a JD, current license to practice law, and a minimum of 6 years of specific industry and/or technical legal experience post licensure; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Health Insurance Law: An understanding of the principles, definitions, and nuances within health insurance law preferred.

• Knowledge of state laws impacting third party administrators preferred.

• Federal Regulations: Knowledge of federal laws that regulate health insurance companies, including MHPAEA, ERISA, ACA, and other federal statutes impacting health insurance preferred.

• Compliance: Understanding of regulatory compliance, how to ensure adherence to laws, regulations, guidelines, and specifications relevant to the health insurance business preferred.

• Contract Law: Experience interpreting, drafting and reviewing employer and member contracts and related materials preferred.

• Experience with provider agreements. Working knowledge of state laws and regulations that apply to third party administrators or health plan operations preferred.

• Excellent communication skills and problem-solving competencies preferred.

• Commercial and Government business-Medicare or Medicaid experience is preferred. 

• Experience working with providers is preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.