Direct and manage all aspects of the regulatory cost filings for existing and new lines of business across the entire company. Cost reports entail categorizing utilization, medical expense, premium, and administrative expenses across types of service, lines of business, and rate cohorts, ultimately reconciling to audited financial statements. The cost reports are presented to regional management both orally and in written summaries prior to filing with regulatory agencies.
- Ensure that all regulatory cost reports are accurate, in compliance with applicable regulations, have appropriate sign off, and are submitted on time.
- Respond to all follow-up questions and concerns from state regulatory agencies.
- Work collaboratively with regional management, Accounting, Actuarial, and Medical Economics to understand and gather the financial data required to produce the required regulatory reports.
- Use tools to develop processes and implement procedures for gathering, categorizing, and allocating claim and financial data. Tools include data warehouse tables, Medical Economics data, Actuarial data, Access Databases, and Excel spreadsheets.
- Proactively work with Accounting to ensure that various financial data is recorded to the correct entities/accounts/product lines and can be segmented in a manner that meets cost reporting criteria.
- Keep abreast of intricacies of new product lines and corresponding reports as required, and develop tools and procedures for report completion.
- Be part of any new business development and implementation team to ensure that require cost reporting can be prepared using current system set ups or develop required data sets.
- Develop and maintain standard operating procedural documentation for all reports.
- Utilize continuous process improvement methodologies to drive efficiency and quality.
- Review all regulatory cost reports with regional partners and corporate executives prior to submission.
- Perform ad-hoc reconciliations and work on special projects, as required.
Education: Bachelors Degree
Experience: 6 - 8 years related experience; previous managerial experience preferred.
Technical Skills/Requirements: Knowledge of health insurance industry