Position Overview The Director of Finance & Regulatory Reporting will serve as a strategic finance leader responsible for driving enterprise-wide financial analysis, healthcare economics insights, forecasting, and regulatory reporting. This role partners closely with executive leadership to provide actionable financial intelligence that informs organizational strategy, operational performance, growth opportunities, and regulatory compliance. The incumbent will lead complex analytical initiatives, oversee financial and healthcare data governance, and develop scalable reporting solutions that enhance decision-making across the organization.
Scope of Role & Responsibilities - Lead the development and execution of the organization's financial analytics strategy, supporting long-term business objectives and enterprise performance management.
- Serve as a key advisor to senior leadership on financial performance, healthcare utilization trends, membership growth, medical cost management, and emerging business risks.
- Direct the analysis of revenues, expenses, medical costs, risk adjustment, utilization patterns, and profitability to identify opportunities for improved financial outcomes.
- Oversee regulatory financial reporting processes, including MMCOR, MLR, VBPTR, and other state and federal reporting requirements, ensuring accuracy, compliance, and timeliness.
- Lead forecasting, budgeting, and financial planning activities, including scenario modeling, trend analyses, and strategic projections.
- Develop and present executive-level financial reviews, board materials, and performance dashboards that translate complex data into meaningful business insights.
- Establish governance and best practices for financial and healthcare data management, reporting methodologies, and analytic standards.
- Partner with Product, Operations, Actuarial, Clinical, Network, and Executive leadership teams to evaluate strategic initiatives, value-based care programs, and cost containment opportunities.
- Lead advanced healthcare economics and claims analysis to identify drivers of performance, utilization trends, provider impacts, and member outcomes.
- Direct the design and implementation of analytical tools, dashboards, and automated reporting capabilities utilizing SQL, BI technologies, and other advanced analytics platforms.
- Oversee complex data mining, predictive modeling, and root-cause analyses to support enterprise decision-making.
- Manage and mentor a team of analysts and finance professionals, fostering a high-performance, data-driven culture.
- Identify process improvement opportunities and lead initiatives to enhance analytical efficiency, reporting accuracy, and business intelligence capabilities.
- Present findings, recommendations, and strategic opportunities to executive leadership and cross-functional stakeholders.
- Lead special projects, enterprise-wide financial initiatives, mergers, growth opportunities, and organizational transformation efforts as assigned.
- Other duties as assigned.
Required Education, Training & Professional Experience - Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, Business Analytics, or related field required; Master's degree preferred.
- Minimum 8-10 years of progressive experience in healthcare finance, financial planning and analysis, managed care, consulting, insurance, or healthcare economics.
- Demonstrated experience leading complex financial analyses, forecasting, and strategic planning initiatives.
- Strong understanding of healthcare reimbursement models, medical cost management, utilization analytics, and regulatory reporting requirements.
- Advanced proficiency in SQL, data visualization platforms, and financial modeling tools.
- Experience with MMCOR, MLR, VBPTR, and healthcare regulatory reporting strongly preferred.
- Experience leading teams and influencing executive-level decision making.
- Strong knowledge of healthcare data structures, claims systems, analytics methodologies, and performance measurement frameworks.
Licensure and/or Certification Required Professional Competencies - Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
