Key Responsibilities
- Monitor and track all state regulatory requirements received from ProCare’s legal team
- Prepare and submit ProCare’s annual CAA (Consolidated Appropriations Act) RxDC reporting to CMS
- Lead the yearly development and submission of ProCare’s 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
- Bachelor’s 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