Senior Manager, Compliance (Medical Loss Ratio)

Centene Corporation•Northampton, MA

2d•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: Manage the compliance department functions, including but not limited to, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements. The purpose of this position is to provide compliance oversight and execution of key Medical Loss Ratio (MLR) compliance activities, including coordinating feedback, decisions, and responses across stakeholders. The role is responsible for developing and maintaining the MLR compliance oversight program, while identifying opportunities to improve business practices and processes to optimize resource utilization and drive operational excellence across MLR initiatives. Provide oversight of submission of timely and accurate contract and regulatory Medical Loss Ratio required report deliverables. Oversee implementation of Medical Loss Ratio contract changes and amendments. Conduct periodic Medical Loss Ratio assessments to ensure compliance against contract requirements. Assist in the creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies. Collaborate with Health Plans and States, where applicable, to ensure compliance with Medical Loss Ratio requirements Manage submission of consumer and provider communication materials, including participation in their review and timely submission to Health Plans and States. Manage composition and delivery of responses to state regulatory agency complaints and inquiries related to Medical Loss Ratio. Support responses to “request for proposals” (RFPs) and new business implementations by completing assigned compliance tasks timely and accurately. Participate in new business implementations, including the identification and tracking of required contract report deliverables and provider/member materials. Design, implement and improve processes to prevent, detect and respond to Medical Loss Ratio compliance issues and concerns related to all federal and state regulatory requirements and contract requirements. Create and deliver Medical Loss Ratio compliance training

Requirements

Bachelor’s degree in health care administration, compliance or related field or equivalent experience.
5-7 years of compliance experience including risk assessment against contract and regulatory requirements, creation and execution of auditing, monitoring and reporting processes, administration of correction action plans, implementation of written policies and procedures, developing and delivering compliance training and education.
2+ years of Managed Care experience.
Management experience including responsibilities for hiring, training, assigning work and managing staff performance.

Responsibilities

Provide oversight of submission of timely and accurate contract and regulatory Medical Loss Ratio required report deliverables.
Oversee implementation of Medical Loss Ratio contract changes and amendments.
Conduct periodic Medical Loss Ratio assessments to ensure compliance against contract requirements.
Assist in the creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies.
Collaborate with Health Plans and States, where applicable, to ensure compliance with Medical Loss Ratio requirements
Manage submission of consumer and provider communication materials, including participation in their review and timely submission to Health Plans and States.
Manage composition and delivery of responses to state regulatory agency complaints and inquiries related to Medical Loss Ratio.
Support responses to “request for proposals” (RFPs) and new business implementations by completing assigned compliance tasks timely and accurately.
Participate in new business implementations, including the identification and tracking of required contract report deliverables and provider/member materials.
Design, implement and improve processes to prevent, detect and respond to Medical Loss Ratio compliance issues and concerns related to all federal and state regulatory requirements and contract requirements.
Create and deliver Medical Loss Ratio compliance training