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Director of Legal Services & Assistant General Cou

The Director of Legal Services and Assistant General Counsel provides a full range of legal services to the company while managing the day- to- day operations of the Legal Department. The Director also leads the Complaints and Appeals Department while actively participating on numerous committees and projects within Health New England (HNE) preventing exposure and costly expenditures on potential legal actions such as law suits, settlements, and administrative fines against HNE. In close collaboration with the VP and General Counsel, the Director of Legal Services & Assistant General Counsel ensures there is a healthy working atmosphere of ethics and integrity in all of Health New England’s endeavors. The Director of Legal Services & Assistant General Counsel will align with the departmental practices and annual objectives as well as support Health New England’s High Performance Coaching Culture and Customer Experience (CX) behaviors that enable ongoing development of a superior and engaging department.

Essential Functions:
Legal Services - 35%
• Provide sound legal advice on contractual matters while adhering to internal controls and ensuring compliance with applicable federal, state, local laws and regulations.
• Provide hands-on expert legal counsel to all HNE’s management team members
• Provide legal services and advice to management on a broad spectrum of issues affecting company operations.
• Bridge legal and business issues arising from general transactions and state and federal legislation, to reach the best possible business solutions for Health New England.
• Proactively update management on any relevant legislative updates, and/or changes to current legislation
• In active consultation with the VP and General Counsel, exercises decision-making authority for the department and ensures department resources are applied properly.
• Coordinate with the Director of Compliance and the Compliance Committee the implementation of legal/governmental changes required within HNE in a timely and efficient fashion.
• Assist departments in adjusting processes and procedures to comply with changes in the law and in responding to member, provider and employer inquiries.
• Work with the Director of Compliance on the review, design and facilitation of relevant training as it relates to laws or regulations that affect HNE operations.

Projects and Strategic Initiatives - 30%
• Participate in Health New England projects and initiatives as an attorney and key leader as required.
• Work with other leaders on company-wide projects aligned to Health New England Business Strategy.
• Develop, as part of the project team, sound policies and strategies that meet legal requirements as well as business needs.
• Provide sound legal advice and thorough understanding of the terms and conditions when drafting, reviewing and/or revising member documents and agreements; contracts and or agreements between Health New England and various
vendors and consultants.
• Assist business leaders with the interpretation and application of contract provisions.
• Work with the Marketing Department to 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

Leadership -15%
• Lead the operations of the Legal Department including Complaints & Appeals.
• Manage team’s workloads and assignments effectively to ensure quality work is delivered on time.
• Partner with associates to develop annual goals, objectives, and metrics that align with the strategic direction of the department.
• Partner with associates to create development plans with a focus on continuous growth. Provide ongoing training to
team member to ensure they remain current in processes, practices, laws, regulations, etc.
• Model the High Performance Culture and CX Principles in daily practices and align with the departments guiding principles.
• Hold team accountable and provide regular coaching sessions and quarterly reviews.
• Build strong relationships with the team and stakeholders throughout the organization.
• Serves as a member of the Director’s team.

Litigation - 10%
• Assist VP and General Counsel in various litigation-related areas. Work with outside litigation counsel to determine case strategy and ensure that legal fees do not exceed budget.
• Review and, if necessary, revise all materials prepared by outside counsel to ensure quality and accuracy
• Coordinate Health New England’s responses to discovery requests and document subpoenas.
• Attend depositions when necessary.
• Work with Health New England’s leaders who have been subpoenaed to testify to prepare them for testimony.
• Research relevant law involved in litigation to ensure that Health New England’s leadership team is sufficiently apprised
of legal risks.
• Negotiate with counsel for the counterparty, as needed.
• Work with insurance company to obtain coverage when available.
• Recommend reasonable settlement amounts to senior leadership 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.

Government Liaison - 10%
• Act as a liaison to various state and federal government agencies including the MA Division of Insurance, MA Attorney
• General’s Office, MA Office of Patient Protection, Department of Health and Human Services, etc.
• Respond to the agencies’ questions and concerns regarding various filings, Health New England’s compliance with
regulatory provisions, etc.
• Negotiate compromises, settlement agreements, product changes, etc. with the agencies as necessary.

Minimum Requirements:
J.D. Degree with a minimum of 8-10 years of relevant legal experience in a law firm, government agency, or corporate legal department. Strong experience within the managed care or insurance industry is required. Strong knowledge and experience in employment law is an asset. Licensed to practice in Massachusetts or Connecticut if registered as in-house counsel in Massachusetts is required. In addition:

• Highly skilled in synthesizing complex legal requirements and numerous operational details to ensure legal compliance and minimize risk to the company.
• Strong broad range of legal expertise and analysis, and demonstrated strong knowledge of Health Care industry.
• Strong knowledge of managed care, health care, and corporate law.
• Exceptional research, writing and verbal communication skills.
• Demonstrated ability to apply legal rules to daily operations pragmatically, with attention to both good legal analysis and goo d business sense- Ability to present an unpopular opinion.
• Ability to advocate to executive management and others the necessity of accepting stringent and unpleasant legal requirements.
• Ability to act proactively to identify and revise company policies that could potentially present a liability.
• Business acumen - Solid understanding of business concepts and strategic alignment. Demonstrated knowledge of managed care law and employment law.
• Exceptional use of judgement and discretion, especially regarding confidential and sensitive matters.
• Demonstrated track record of providing a positive, creative, problem-solving approach to address challenging legal issues and conflict management.
• Strong leadership, emotional intelligence, political savviness skills and ability to interface with tact and diplomacy at all levels of the organization while building an effective team.
• Seasoned facilitator with strong presentation skills.
• Strong organizational skills with the ability to establish plans; manage a large workload with multiple assignment and conflict priorities while meeting deadlines in a high demand environment.
• Demonstrated ability to maintain composure and critical thinking skills under pressure.
• Collaborative mindset – able to listen actively, develop buy-in, and drive action across a broad set of stakeholders.
• Demonstrated competencies including influence management, collaboration and negotiation.
• Demonstrated ability to drive for results, prioritize, plan and manage multiple projects independently and effectively.
• Advanced skills in Microsoft Office Suite required.

Physical Requirements:
Data Entry Continually (5 1/2 - 8 hrs)
Hearing Continually (5 1/2 - 8 hrs)
Seeing Continually (5 1/2 - 8 hrs)
Sitting Continually (5 1/2 - 8 hrs)
Talking Frequently (2 1/2 - 5 1/2 hrs)
Travel Occasionally (1/4 - 2 1/2 hrs)

Supervisory Responsibilities:
- Direct Supervision - Complaints and Appeal Manager (1x)
- Indirect Supervision – Complaints and Appeal Coordinator (3x)

Time:  Full time
Salary:  Hourly
Category:  Legal

Updated: 7/29/2019 7:15:32 AM

Job Contact:
Elisa Rose

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1 Monarch Pl
Springfield, MA 01144-1500