Senior Analyst, Medical Loss Ratio
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Montana • United States
Visit company websiteExplore more
Salary
💰 $87,700 - $157,800 per year
Job Level
About the role
- Responsible for leading Medical Loss Ratio (MLR) compliance and reporting activities for assigned lines of business
- Ensure accurate calculation, documentation, and timely submission of required federal and state filings
- Partner with Finance, Actuarial, Legal, and operational stakeholders to interpret regulatory requirements
- Strengthen controls and audit readiness, identify and mitigate compliance risk
- Drive process improvements across end-to-end MLR operations, including rebate support and regulatory examinations
- Provide oversight of methodology, assumptions, and classifications for compliance with federal and state MLR regulations
- Manage governance frameworks, controls, and documentation standards, ensuring comprehensive audit trails and regulatory compliance
- Monitor MLR performance against thresholds, assess emerging risks, and oversee mitigation strategies
- Lead MLR rebate process coordination and partner with stakeholders to validate inputs and ensure compliance
- Lead periodic monitoring, reviews, and internal audits of MLR data and processes
Requirements
- Bachelor's Degree Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field; or equivalent experience required
- 4+ years Health plan/managed care environment with direct involvement in MLR reporting/compliance, regulatory reporting, finance/controllership, actuarial support, healthcare reimbursement/claims, or audit/compliance required
- Experience applying MLR concepts, data elements, and regulatory expectations, including interpreting regulatory guidance and translating requirements into operational processes and controls required
- Experience performing complex analysis using large datasets, including reconciliations and variance/root-cause analysis; experience producing clear documentation and written responses for regulatory inquiries required
- Experience leading cross-functional work efforts, managing competing deadlines, and communicating effectively with senior leaders and external stakeholders required
- Proficiency with Excel and reporting/analytics tools; experience with health plan finance/claims systems and data warehouses required
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medical Loss Ratio (MLR) complianceregulatory reportingdata analysisvariance analysisroot-cause analysisdocumentation standardsaudit readinessprocess improvementshealthcare reimbursementfinancial analysis
Soft Skills
leadershipcommunicationcross-functional collaborationstakeholder managementproblem-solvingtime managementrisk assessmentattention to detailorganizational skillsanalytical thinking