Centene Corp

Senior Manager, Medical Loss Ratio

Centene Corp • $107K — $199K *
US-AnywhereRemote in Missouri, US
Healthcare
Less than 5 years of experience
1 month ago
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, or related field required; Master's degree and JD preferred
  • 4+ years' experience in healthcare finance, managed care operations, or related fields
  • Experience with federal and state MLR guidance and methodology interpretation
  • Strong skills in complex analysis oversight and documentation for audits
  • Advanced proficiency in Excel and reporting/analytics tools

Responsibilities

  • Oversee MLR reporting calendar and ensure timely submissions to regulators
  • Review MLR methodology and ensure alignment with regulatory standards
  • Lead cross-functional teams to resolve issues impacting MLR results
  • Design and maintain MLR governance and internal controls
  • Monitor MLR performance and develop risk mitigation strategies
  • Plan and execute MLR rebates while ensuring compliance
  • Conduct deeper analyses and audits to maintain oversight and controls
  • Provide executive-ready reporting on MLR compliance and recommendations

Benefits

  • Comprehensive health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work options including remote, hybrid, and office schedules
Full Job Description

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose:
Accountable for the Medical Loss Ratio (MLR) compliance and reporting program across assigned lines of business, ensuring accurate calculation, strong governance and controls, and timely submission of federal and state filings. Provides strategic and operational leadership for end-to-end MLR activities, including methodology oversight, documentation standards, audit readiness, rebate execution, and regulatory examinations. Leads and develops a team, sets priorities and deliverables, and drives cross-functional alignment with Finance, Actuarial, Legal/Compliance, Government Affairs, and operational partners. Serves as the escalation point for complex interpretation and judgment matters, proactively identifies and mitigates enterprise risk, and sponsors continuous improvement initiatives that strengthen data quality, consistency, and regulatory confidence.

  • Provides oversight of the MLR reporting calendar and delivery model for assigned lines of business; set expectations, assign work, and ensure filings to CMS and state regulators are accurate, complete, and submitted on time.
  • Provides oversight and final review of MLR methodology, assumptions, and classifications; ensure consistent application of federal and state requirements (e.g., ACA commercial markets, Medicare Advantage, Medicaid) and alignment with internal policy.
  • Leads cross-functional forums and working sessions with Finance, Actuarial, Legal/Compliance, Government Affairs, and operations to drive decisions, resolve issues, and ensure clear ownership of actions that impact MLR results and regulatory posture.
  • Designs, implements, and maintains MLR governance, internal controls, and documentation standards; approve key artifacts and ensure an audit-ready trail from data sources through final filing outputs.
  • Oversees MLR performance monitoring and threshold management; interprets drivers, evaluates emerging risk, and sponsors mitigation strategies and corrective action plans in partnership with business owners.
  • Has oversight of MLR rebate planning and execution, including governance over inputs, leadership approvals, and downstream communications to ensure compliance with federal and state requirements and timelines.
  • Establishes a risk-based monitoring and review plan; oversees deeper-dive analyses, internal audits, and control testing; ensures remediation is implemented, validated, and sustained.
  • Maintains awareness of legislative and regulatory changes impacting MLR; assess impact, advise leadership on options and risk, and lead implementation of required policy, process, and control updates.
  • Maintains oversight of MLR-related policies, procedures, and tools (or their enterprise alignment); set standards for accurate classification of claims, quality improvement activities, and administrative expenses, and resolve interpretation disputes.
  • Serves as the primary accountable leader for regulatory inquiries, audits, and examinations related to MLR; approve responses, ensure supporting documentation quality, and coordinate cross-functional participation.
  • Coaches and develops team members; provides consultation and training to stakeholders on MLR requirements, controls, and risk management expectations.
  • Provides executive-ready reporting and recommendations to senior leadership and governance committees on MLR compliance status, key risks, control effectiveness, and remediation progress.
  • Contributes process improvement and data governance initiatives (e.g., standardization, automation, reconciliations, evidence retention) to improve oversight, efficiency, and consistency across the MLR lifecycle.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience:

  • Bachelor's Degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field; or equivalent experience required
  • Juris Doctor (JD) preferred
  • Master's Degree preferred
  • 4+ years healthcare finance, managed care operations or related experience required
  • Experience interpreting and applying federal and state MLR guidance, including use of judgment to resolve complex classification and methodology questions and translate requirements into scalable processes and controls required
  • Experience providing oversight and final review of complex analyses (e.g., reconciliations, variance/root-cause analysis) and ensuring documentation quality appropriate for audits and regulatory submissions required
  • Experience communicating with and influencing senior leaders and cross-functional stakeholders, including escalating risks/issues and presenting clear recommendations and decision points required
  • Advanced experience with Excel and reporting/analytics tools required
  • Experience with health plan finance/claims systems and data warehouses preferred


Licenses/Certifications:

  • CPA, CMA, CIA, or other relevant accounting/audit credential preferred
  • CHC, CRC or other healthcare compliance certification preferred

Pay Range: $107,700.00 - $199,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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