Senior Manager, Medical Loss Ratio
Core
Accountable for Medical Loss Ratio (MLR) compliance, reporting, and governance across assigned lines of business, ensuring accurate calculations, timely federal/state filings, and audit readiness.
Role type
Senior Manager, Regulatory Compliance & Reporting
Builds
MLR compliance programs, regulatory filings, and governance frameworks for health plans
Domain
US Healthcare / Regulatory Compliance
Deliverable
dashboards & analysis
Required skills
MLR methodology oversight, federal/state regulatory interpretation, cross-functional leadership, risk management, audit readiness, rebate execution, policy design, data governance, executive reporting
Preferred skills
JD, Master's degree, CPA/CMA/CIA, CHC/CRC, health plan finance systems, data warehouses
Technologies
Excel, reporting/analytics tools, health plan finance/claims systems, data warehouses
Responsibilities
Oversee MLR reporting calendar and delivery model for assigned lines of business; Provide oversight and final review of MLR methodology, assumptions, and classifications; Lead cross-functional forums to drive decisions and resolve issues; Design and maintain MLR governance, internal controls, and documentation standards; Oversee MLR performance monitoring and threshold management; Manage MLR rebate planning and execution; Establish risk-based monitoring and review plans; Maintain awareness of legislative/regulatory changes and lead implementation; Serve as primary accountable leader for regulatory inquiries and audits; Coach and develop team members; Provide executive-ready reporting to senior leadership
Seniority
Senior Manager, strategic & operational leadership