Senior Financial Analyst – Medicare Advantage Finance

Responsibilities

• Prepare monthly, quarterly, and annual CMS financial filings in a timely and accurate manner.
• Complete annual Medicare Part C & D Bid pricing support documents.
• Ensure full compliance with National Association of Insurance Commissioners (NAIC) reporting standards.
• Cook with external auditors for all quarterly & annual regulatory financial reviews.
• Submit accurate Medical Loss Ratio (MLR) reports to CMS.
• Reconcile monthly CMS Membership Summary Reports (MMSR) against internal data.
• Track and validate Plan Payment Reports (PPR) for payment discrepancies.
• Analyze Risk Adjustment Processing System (RAPS) and Encounter Data System (EDS) impacts.
• Monitor Mid-Year and Final Risk Score settlements from CMS.
• Investigate and resolve premium variances at the member level.
• Aid in month-end close activities for the Medicare Advantage business unit.
• Prepare journal entries for capitation revenues and premium receivables.
• Analyze actual-to-budget variances for premium revenues and medical expenses.
• Develop monthly financial dashboards for senior leadership review.
• Forecast premium revenues based on enrollment trends and risk scores.
• Complete ad-hoc projects or tasks, as assigned.

Requirements

• Minimum Qualifications: Bachelor’s degree in Finance, Accounting, or a related field; minimum 3–5 years of financial analysis experience in healthcare; at least 2 years of direct experience with Medicare Advantage plans; strong understanding of GAAP and/or statutory accounting principles; proficiency in MS Office.
• Technical Skills: Advanced proficiency in Microsoft Excel (VLOOKUPs, Pivot Tables, Power Query); strong SQL querying skills to extract complex healthcare data; experience using financial ERP systems (e.g., QuickBooks Online, Oracle, Workday, SAP).
• Professional Competencies: Deep understanding of CMS payment methodologies and risk adjustment models; familiarity with healthcare coding frameworks (ICD-10, CPT, HCPCS); excellent analytical, problem-solving, and data validation skills; excellent written and verbal communication skills; driven, detail-oriented, and strong analytical and organization skills with the ability to identify issues and provide recommendations for process improvements; ability to multi-task and adapt with changes in tasks and timelines; experience working in a fast-paced and heavy-deadline-driven environment; willingness to work extra hours, as necessary.

Qualifications

• Experience working in a fast-paced and heavy-deadline-driven environment.
• Willingness to work extra hours, as necessary.

Benefits

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision Insurance
• Life Insurance

Schedule

Full-time onsite (100% in-office)

Hours of Operation

9am – 6pm

Location

Huntington Beach, CA

Compensation Range

$95,000 – $110,000 annually