Senior Manager, Medical Loss Ratio

Centene Corporation•Remote-MO, MO

1d•$107,700 - $199,300•Remote

About The Position

Centene is seeking a Senior Manager, Medical Loss Ratio (MLR) to lead the MLR compliance and reporting program for assigned lines of business. This role ensures accurate calculations, strong governance, and timely submission of federal and state filings. The position provides strategic and operational leadership for all MLR activities, including methodology, documentation, audit readiness, rebate execution, and regulatory examinations. The Senior Manager will lead and develop a team, set priorities, and drive cross-functional alignment with key departments such as Finance, Actuarial, Legal/Compliance, and Government Affairs. This role serves as an escalation point for complex issues, proactively identifies and mitigates enterprise risk, and champions continuous improvement initiatives to enhance data quality, consistency, and regulatory confidence. The position offers flexibility to work remotely from home anywhere in the Continental United States.

Requirements

Bachelor's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field; or equivalent experience required
4+ years healthcare finance, managed care operations or related experience required
Experience interpreting and applying federal and state MLR guidance, including use of judgment to resolve complex classification and methodology questions and translate requirements into scalable processes and controls required
Experience providing oversight and final review of complex analyses (e.g., reconciliations, variance/root-cause analysis) and ensuring documentation quality appropriate for audits and regulatory submissions required
Experience communicating with and influencing senior leaders and cross-functional stakeholders, including escalating risks/issues and presenting clear recommendations and decision points required
Advanced experience with Excel and reporting/analytics tools required
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Nice To Haves

Juris Doctor (JD) preferred
Master's Degree preferred
Experience with health plan finance/claims systems and data warehouses preferred
CPA, CMA, CIA, or other relevant accounting/audit credential preferred
CHC, CRC or other healthcare compliance certification preferred

Responsibilities

Provide oversight of the MLR reporting calendar and delivery model for assigned lines of business; set expectations, assign work, and ensure filings to CMS and state regulators are accurate, complete, and submitted on time.
Provide oversight and final review of MLR methodology, assumptions, and classifications; ensure consistent application of federal and state requirements (e.g., ACA commercial markets, Medicare Advantage, Medicaid) and alignment with internal policy.
Lead cross-functional forums and working sessions with Finance, Actuarial, Legal/Compliance, Government Affairs, and operations to drive decisions, resolve issues, and ensure clear ownership of actions that impact MLR results and regulatory posture.
Design, implement, and maintain MLR governance, internal controls, and documentation standards; approve key artifacts and ensure an audit-ready trail from data sources through final filing outputs.
Oversee MLR performance monitoring and threshold management; interpret drivers, evaluate emerging risk, and sponsor mitigation strategies and corrective action plans in partnership with business owners.
Oversee MLR rebate planning and execution, including governance over inputs, leadership approvals, and downstream communications to ensure compliance with federal and state requirements and timelines.
Establish a risk-based monitoring and review plan; oversee deeper-dive analyses, internal audits, and control testing; ensure remediation is implemented, validated, and sustained.
Maintain awareness of legislative and regulatory changes impacting MLR; assess impact, advise leadership on options and risk, and lead implementation of required policy, process, and control updates.
Maintain oversight of MLR-related policies, procedures, and tools (or their enterprise alignment); set standards for accurate classification of claims, quality improvement activities, and administrative expenses, and resolve interpretation disputes.
Serve as the primary accountable leader for regulatory inquiries, audits, and examinations related to MLR; approve responses, ensure supporting documentation quality, and coordinate cross-functional participation.
Coach and develop team members; provide consultation and training to stakeholders on MLR requirements, controls, and risk management expectations.
Provide executive-ready reporting and recommendations to senior leadership and governance committees on MLR compliance status, key risks, control effectiveness, and remediation progress.
Contribute to process improvement and data governance initiatives (e.g., standardization, automation, reconciliations, evidence retention) to improve oversight, efficiency, and consistency across the MLR lifecycle.
Perform other duties as assigned.
Comply with all policies and standards.