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