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Regulatory Operations Reporting Analyst

WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294301)

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Regulatory Operations Reporting Analyst is responsible for supporting the Service & Operations division and ensuring accurate and timely regulatory reporting. This role translates regulatory requirements into reporting requirements, and creates, validates, and submits reports, collaborating with business areas and IT for data acquisition and maintaining data integrity. Reporting accuracy and timeliness is required to avoid regulatory penalties and corrective action.

Our Investment in You:

· Full-time remote work

· Competitive salaries

· Excellent benefits

Key Functions/Responsibilities:

• Creates and submits monthly, quarterly and annual regulatory reporting, working with business areas to validate accuracy of data

• Creates and submits ad hoc regulatory reports as required

• Develops business requirements and works with IT to obtain data and create reports

• Maintains the accuracy and integrity of data universe tables

• Performs quality review of data to ensure reports contain required data

• Regular internal audits of data to ensure accuracy and preparedness

• Works with vendors to ensure reporting timeliness and accuracy; works with Sourcing and Supplier Management to recover liquidated damages

• Works with business leaders to validate attestations

• Oversees the development and maintenance of internal controls and quality assurance to monitor against all applicable standards

• Participates in appropriate committees that support program compliance

• Acts as liaison to Compliance, Legal and Public Partnerships Departments

• Creates centralized repositories for regulatory reporting and RFP materials

• Reporting includes but is not limited to:

• SCO reporting – monthly, quarterly, annual managed by Public Partnerships

• ACO/MCO reporting – monthly, quarterly, annual managed by Public Partnerships

• NH Medicaid reporting – monthly, quarterly, annual managed by NH Medicaid Operations

• Annual CMS Part C reporting – ODAG

• Audit data universe tables

• Coordination of supplier reporting

• State and federal ad hoc reporting as requested

Supervision Exercised:

· This is an individual contributor role

Supervision Received:

· General guidance is received weekly

· This role will report into and support the Service & Operations division though will work closely with the corporate compliance, legal and public affairs departments

· This role will also work closely with the Service & Operations division regulatory operations manager and business leaders

· This role may also interact with internal or external auditors or state and federal agencies

Qualifications:

Education Required:

· Bachelor’s Degree in Data Science, Mathematics, Statistics or an equivalent combination of education, training and experience is required

Education Preferred:

· Master’s degree in Data Science, Mathematics, Statistics or a related field preferred

Experience Required:

· 5+ years of experience in data analysis or related roles

· Proficiency in statistical software (e.g., Python, R) and data manipulation tools (e.g., Excel(VBA), SQL, PowerQuery)

· Experience with data visualization tools (e.g., Tableau, Power BI)

Experience Preferred/Desirable:

· 3-5 years’ experience with Medicare or Medicaid regulatory reporting

· Advanced proficiency in statistical software (e.g., Python, R) and data manipulation tools (e.g., SQL).

· Expertise in data visualization tools (e.g., Tableau, Power BI) and complex dashboard creation.

Required Licensure, Certification or Conditions of Employment:

· Successful completion of pre-employment background check

· Employees must provide high speed internet meeting minimum required standards

· Employees are required to have a quiet and distraction-free working space and protect confidential information

Competencies, Skills, and Attributes:

· Strong skills in data analysis and statistical modeling

· Experience using data visualization tools such as Tableau and Power BI

· Strong Excel skills

· Familiarity with SQL, VBA, Python or other programming languages

· Understanding of data warehousing and ETL techniques

· Strong problem-solving skills and ability to work independently

· Excellent organization and proven process improvement skills

· Ability to discern regulatory details and requirements from contracts

· Demonstrated ability to successfully plan, organize and manage projects

· Detail oriented, excellent proof reading and editing skills

· Demonstrated ability in facilitating cross-functional teams and encouraging positive collaboration and communication

· Demonstrated ability to work independently and manage multiple projects simultaneously

· Demonstrated commitment to excellent customer service for both internal and external customers

· Understands and is able to work in highly matrixed environments

· Effective collaborative and proven process improvement skills

· Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts

Working Conditions and Physical Effort:

· Ability to work in a fast paced environment

· Regular and reliable attendance is an essential function of the position

· Work is normally performed in remote office work environment; limited travel may be required

· Ability to work East Coast business hours

· No or very limited physical effort required

· No or very limited exposure to physical risk

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294301)

Important info on employment offer scams:

According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to individuals via text, we do not ask or require downloads of any applications, or “apps”, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC (https://consumer.ftc.gov/consumer-alerts/2023/01/looking-job-scammers-might-be-looking-you?utm_source=govdelivery) .