Job Description

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