[Hiring] Senior Analyst, Medical Loss Ratio @Centene Corporation

Role Description

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.

• Responsible for leading Medical Loss Ratio (MLR) compliance and reporting activities for assigned lines of business.
• Ensures accurate calculation, documentation, and timely submission of required federal and state filings.
• Partners with Finance, Actuarial, Legal, and operational stakeholders to interpret regulatory requirements.
• Strengthens controls and audit readiness, identifies and mitigates compliance risk, and drives process improvements across end-to-end MLR operations.
• 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.
• Partners with Finance, Actuarial, Legal/Compliance, Government Affairs, and operational teams to challenge first-line activities.
• 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.
• Leads periodic monitoring, reviews, and internal audits of MLR data and processes to identify gaps.
• Tracks legislative and regulatory changes impacting MLR; advises on operational and policy updates.
• Assists in the development and maintenance of policies, procedures, and tools that promote accurate classification of claims.
• Serves as a point of accountability for regulatory inquiries, examinations, and audits.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• 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 in a 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 required.
• Experience performing complex analysis using large datasets required.
• Experience leading cross-functional work efforts, managing competing deadlines, and communicating effectively required.
• Proficiency with Excel and reporting/analytics tools required.

Requirements

• 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.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.