Senior Compliance Analyst (Medical Loss Ratio)

Centene Corporation•Northampton, MA

3d•Remote

About The Position

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. Position Purpose: Assist in maintaining Centene Corporation’s Medical Loss Ratio Compliance Program. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance medical loss ratio auditing and monitoring strategies.

Requirements

Bachelor’s degree in related legal field or equivalent experience.
3+ years of related experience in compliance privacy and/or regulatory affairs.
Experience in project management with working knowledge of laws and/or regulations in area of compliance, in particular HIPAA, and state regulations.

Nice To Haves

Master’s or Juris Doctorate degree preferred and maybe considered in lieu of experience.

Responsibilities

Respond to external requests for information required by the organization for its medical loss ratio regulatory filings
Manage compliance oversight or medical loss ratio reporting and assist in respond to inquiries from state and federal regulatory agencies
Manage ethics and compliance medical loss ratio projects or implementations
Review and synthesize regulatory requirements and create policy and/or position statements
Communicate state and federal requirements to internal and external clients
Provide development guidance and assist in the identification, implementation, and maintenance of compliance policies, procedures and work instructions
Assist in the identification, analysis, and resolution of medical loss ratio compliance issues.
Maintain and review medical loss ratio regulatory documentation necessary to maintain corporate standards
Perform periodic compliance audits, risk assessments and conducts related to ongoing compliance monitoring activities
Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members
Serve as a company-wide resource and liaison on medical loss ratio policies, contract issues and provisions, communications, workflow, and quality improvements initiatives