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

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

Senior Analyst, Medical Loss Ratio

Key skills