Regulatory Reporting Analyst

Key Responsibilities

• Monitor and track all state regulatory requirements received from ProCares legal team
• Prepare and submit ProCares annual CAA (Consolidated Appropriations Act) RxDC reporting to CMS
• Lead the yearly development and submission of ProCares URAC accreditation reporting including building and automating the required annual accreditation reports and supporting data validations and follow-up requests from auditors
• Build and maintain the SQL queries data extracts and reports needed to satisfy each regulatory filing pulling from claims eligibility and pricing data sources
• Create and manage a master calendar of all state and federal filing deadlines and ensure on-time accurate submission
• Validate report accuracy and completeness prior to submission including reconciliation against source systems
• Maintain documentation of report logic data sources and submission processes for each regulatory requirement
• Serve as the primary contact for regulator inquiries audits and data requests related to PBM reporting
• Partner with Legal Rebates and Finance teams to interpret new regulations and translate them into reporting specifications
• Identify opportunities to automate and streamline recurring regulatory reports
• Track and report on the status of all open regulatory reporting obligations to leadership

Required Qualifications

• Bachelors degree in a related field (Healthcare Administration Business Finance Information Systems or similar) or equivalent work experience
• 2 years of experience in regulatory reporting compliance or data analysis ideally within a PBM health plan or healthcare payer environment
• SQL proficiency required able to independently write and troubleshoot complex queries (joins aggregations subqueries) against large claims and eligibility datasets
• Working knowledge of PBM operations and terminology (claims adjudication eligibility formulary rebates)
• Strong attention to detail and ability to manage multiple concurrent deadlines across different states and agencies
• Excellent written and verbal communication skills including the ability to explain regulatory and technical concepts to non-technical stakeholders
• Proficiency with Excel for data validation and ad hoc analysis

Preferred Qualifications

• Direct experience with PBM state licensing NCPDP Medicaid MCO or CMS Part D reporting requirements
• Familiarity with data warehouse and BI tools (e.g. QlikView Power BI Tableau) used to build and automate regulatory reports
• Experience working directly with state regulators or CMS on audits examinations or data requests
• Paralegal compliance or health law background
• Experience with Python or another scripting language for data automation

Required Experience:

IC