Senior Analyst, Medical Loss Ratio

Responsible for leading Medical Loss Ratio (MLR) compliance and reporting for assigned lines of business. Ensures accurate calculations, documentation, and timely federal and state filings while partnering cross-functionally to strengthen controls and audit readiness.

• Leads end-to-end MLR reporting activities and ensures timely CMS/state filings
• Oversees methodology, assumptions, and classifications to comply with federal and state MLR regulations
• Partners with Finance, Actuarial, Legal/Compliance, and operational teams to escalate and resolve MLR risks
• Manages governance frameworks, controls, and comprehensive audit trails
• Monitors MLR performance, leads rebate coordination, and supports audits, corrective action plans, and regulatory inquiries

Focuses on regulatory compliance operations for MLR, including methodology oversight, monitoring performance against thresholds, and coordinating rebate process support. Builds and maintains documentation standards, governance frameworks, and supports audit trails for examinations, inquiries, and internal reviews.

The ideal candidate is a senior compliance analyst with hands-on experience leading Medical Loss Ratio (MLR) compliance and end-to-end MLR reporting. They can accurately interpret federal and state requirements across ACA commercial markets, Medicare Advantage, and Medicaid, and demonstrate strong audit readiness with documented controls and corrective action planning.