Job Overview
Location
Remote-MO
Job Type
Full-time
Category
Data Science
Date Posted
June 3, 2026
Full Job Description
đź“‹ Description
- • Oversee the Medical Loss Ratio (MLR) compliance and reporting program across assigned lines of business, ensuring accurate, complete, and timely submission of federal and state filings to CMS and state regulators.
- • Provide final review and oversight of MLR methodology, assumptions, and classifications, ensuring consistent application of federal and state requirements including ACA commercial markets, Medicare Advantage, and Medicaid.
- • Lead cross-functional collaboration with Finance, Actuarial, Legal/Compliance, Government Affairs, and operations teams to resolve complex MLR issues, drive decision-making, and establish clear ownership of actions impacting MLR outcomes.
- • Design, implement, and maintain MLR governance frameworks, internal controls, and documentation standards to ensure audit readiness and a defensible trail from data sources through final regulatory filings.
- • Monitor MLR performance and threshold management, interpret key drivers of variance, evaluate emerging risks, and sponsor mitigation strategies and corrective action plans in partnership with business owners.
- • Oversee MLR rebate planning and execution, including governance of inputs, leadership approvals, and downstream communications to ensure compliance with federal and state timelines and requirements.
- • Establish and maintain a risk-based monitoring and review plan, overseeing deeper-dive analyses, internal audits, and control testing, and ensuring remediation is implemented, validated, and sustained.
- • Track and assess legislative and regulatory changes impacting MLR, advise senior leadership on implications and risk, and lead implementation of necessary policy, process, and control updates.
- • Maintain oversight of MLR-related policies, procedures, and tools, setting standards for accurate classification of claims, quality improvement activities, and administrative expenses, and resolving interpretation disputes.
- • Serve as the primary accountable leader for regulatory inquiries, audits, and examinations related to MLR, approving responses and ensuring quality of supporting documentation and cross-functional coordination.
- • Coach and develop team members, providing consultation and training to stakeholders on MLR requirements, controls, and risk management expectations.
- • Deliver 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 including standardization, automation, reconciliations, and evidence retention to enhance oversight, efficiency, and consistency across the MLR lifecycle.
- • Ensure compliance with all company policies and regulatory standards in all MLR-related activities.
🎯 Requirements
- • Bachelor’s Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or related field; or equivalent experience
- • 4+ years of healthcare finance, managed care operations, or related experience
- • Experience interpreting and applying federal and state MLR guidance with judgment to resolve complex classification and methodology questions
- • Experience providing oversight and final review of complex analyses (e.g., reconciliations, variance/root-cause analysis) with audit-quality documentation
- • Advanced proficiency in Excel and reporting/analytics tools
- • Experience communicating with and influencing senior leaders and cross-functional stakeholders to escalate risks and present decision-ready recommendations
🏖️ Benefits
- • Competitive pay ranging from $107,700.00 to $199,300.00 per year
- • Comprehensive benefits package including health insurance, 401(k), and stock purchase plans
- • Tuition reimbursement and paid time off plus holidays
- • Flexible work arrangements including remote, hybrid, field, or office schedules
- • Opportunities for professional development and career advancement
- • Employment-based visa sponsorship is not available for this role
Skills & Technologies
About Centene Corporation
Centene Corporation is a publicly traded managed-care enterprise that arranges health-benefit programs for government-sponsored and privately insured individuals. Operating across all 50 U.S. states and internationally, the company focuses on under-insured and uninsured populations through Medicaid, Medicare, and Marketplace offerings. Its services include behavioral health, pharmacy benefits, vision, dental, telehealth, and in-house clinical programs. Centene partners with physicians, hospitals, and community organizations to coordinate cost-effective care, emphasizing data analytics and value-based reimbursement models. Headquartered in St. Louis, Missouri, it serves more than 25 million members, positioning itself as a leading intermediary between payers and healthcare providers.
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