Senior Analyst, Medical Loss Ratio
Centene Corporation, Des Moines, IA, United States
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Position Purpose Responsible for leading Medical Loss Ratio (MLR) compliance and reporting activities for assigned lines of business, ensuring accurate calculation, documentation, and timely submission of required federal and state filings. This role partners with Finance, Actuarial, Legal, and operational stakeholders to interpret regulatory requirements, strengthen controls and audit readiness, identify and mitigate compliance risk, and drive process improvements across end‑to‑end MLR operations, including rebate support and regulatory examinations.
Leads end-to-end MLR reporting activities, ensuring accuracy, completeness, and timely submission of filings to CMS and state regulators.
Provides oversight of methodology, assumptions, and classifications to ensure compliance with federal and state MLR regulations (e.g., ACA commercial markets, Medicare Advantage, Medicaid).
Partners with Finance, Actuarial, Legal/Compliance, Government Affairs, and operational teams to challenge first-line activities, elevate risks, and guide resolution of issues affecting MLR results and audit readiness.
Manages governance frameworks, controls, and documentation standards, ensuring comprehensive audit trails and regulatory compliance.
Monitors MLR performance against thresholds, assesses emerging risks, and oversees mitigation strategies and corrective action plans.
Leads MLR rebate process coordination, partnering with cross‑functional stakeholders to validate inputs, support approvals, and ensure compliance with federal and state timelines.
Leads periodic monitoring, reviews, and internal audits of MLR data and processes to identify gaps, validate remediation, and prevent recurrence.
Tracks legislative and regulatory changes impacting MLR; advises on operational and policy updates to maintain compliance and control effectiveness.
Assists in the development and maintenance of policies, procedures, and tools that promote accurate classification of claims, quality improvement, and administrative expenses.
Serves as a point of accountability for regulatory inquiries, examinations, and audits, reviewing and approving responses and supporting documentation.
Provides guidance, consultation, and training to stakeholders on MLR requirements, controls, and risk management best practices.
Reports to senior leadership on MLR compliance, risks, control effectiveness, and remediation progress.
Drives process improvements, data governance, and workflow enhancements to strengthen oversight, efficiency, and consistency across MLR operations.
Performs other duties as assigned.
Complies with all policies and standards.
Education & Experience
Bachelor's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field; or equivalent experience required.
Juris Doctor (JD) preferred.
4+ years Health plan/managed care environment with direct involvement in one or more of the following: MLR reporting/compliance, regulatory reporting, finance/controllership, actuarial support, healthcare reimbursement/claims, or audit/compliance.
Experience applying MLR concepts, data elements, and regulatory expectations, including interpreting regulatory guidance and translating requirements into operational processes and controls.
Experience performing complex analysis using large datasets, including reconciliations and variance/root‑cause analysis; experience producing clear documentation and written responses for regulatory inquiries.
Experience leading cross‑functional work efforts, managing competing deadlines, and communicating effectively with senior leaders and external stakeholders.
Proficiency with Excel and reporting/analytics tools; experience with health plan finance/claims systems and data warehouses.
Licenses & Certifications
CPA, CMA, CIA, or other relevant accounting/audit credential preferred.
CHC, CRC or other healthcare compliance certification preferred.
Master's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field preferred.
Pay Range $87,700.00 - $157,800.00 per year.
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
#J-18808-Ljbffr
Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Position Purpose Responsible for leading Medical Loss Ratio (MLR) compliance and reporting activities for assigned lines of business, ensuring accurate calculation, documentation, and timely submission of required federal and state filings. This role partners with Finance, Actuarial, Legal, and operational stakeholders to interpret regulatory requirements, strengthen controls and audit readiness, identify and mitigate compliance risk, and drive process improvements across end‑to‑end MLR operations, including rebate support and regulatory examinations.
Leads end-to-end MLR reporting activities, ensuring accuracy, completeness, and timely submission of filings to CMS and state regulators.
Provides oversight of methodology, assumptions, and classifications to ensure compliance with federal and state MLR regulations (e.g., ACA commercial markets, Medicare Advantage, Medicaid).
Partners with Finance, Actuarial, Legal/Compliance, Government Affairs, and operational teams to challenge first-line activities, elevate risks, and guide resolution of issues affecting MLR results and audit readiness.
Manages governance frameworks, controls, and documentation standards, ensuring comprehensive audit trails and regulatory compliance.
Monitors MLR performance against thresholds, assesses emerging risks, and oversees mitigation strategies and corrective action plans.
Leads MLR rebate process coordination, partnering with cross‑functional stakeholders to validate inputs, support approvals, and ensure compliance with federal and state timelines.
Leads periodic monitoring, reviews, and internal audits of MLR data and processes to identify gaps, validate remediation, and prevent recurrence.
Tracks legislative and regulatory changes impacting MLR; advises on operational and policy updates to maintain compliance and control effectiveness.
Assists in the development and maintenance of policies, procedures, and tools that promote accurate classification of claims, quality improvement, and administrative expenses.
Serves as a point of accountability for regulatory inquiries, examinations, and audits, reviewing and approving responses and supporting documentation.
Provides guidance, consultation, and training to stakeholders on MLR requirements, controls, and risk management best practices.
Reports to senior leadership on MLR compliance, risks, control effectiveness, and remediation progress.
Drives process improvements, data governance, and workflow enhancements to strengthen oversight, efficiency, and consistency across MLR operations.
Performs other duties as assigned.
Complies with all policies and standards.
Education & Experience
Bachelor's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field; or equivalent experience required.
Juris Doctor (JD) preferred.
4+ years Health plan/managed care environment with direct involvement in one or more of the following: MLR reporting/compliance, regulatory reporting, finance/controllership, actuarial support, healthcare reimbursement/claims, or audit/compliance.
Experience applying MLR concepts, data elements, and regulatory expectations, including interpreting regulatory guidance and translating requirements into operational processes and controls.
Experience performing complex analysis using large datasets, including reconciliations and variance/root‑cause analysis; experience producing clear documentation and written responses for regulatory inquiries.
Experience leading cross‑functional work efforts, managing competing deadlines, and communicating effectively with senior leaders and external stakeholders.
Proficiency with Excel and reporting/analytics tools; experience with health plan finance/claims systems and data warehouses.
Licenses & Certifications
CPA, CMA, CIA, or other relevant accounting/audit credential preferred.
CHC, CRC or other healthcare compliance certification preferred.
Master's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field preferred.
Pay Range $87,700.00 - $157,800.00 per year.
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
#J-18808-Ljbffr