Technical Analyst

We are seeking a Technical Analyst with strong experience in Medical Management compliance reporting to support regulatory and operational reporting needs. This role focuses on developing, validating, and submitting compliance reports while ensuring adherence to regulatory standards and data accuracy across healthcare systems.

• Develop, enhance, and maintain Medical Management compliance reports including ODAG, CDAG, and other regulatory submissions.
• Analyze regulatory requirements and translate them into technical specifications and reporting logic.
• Perform data validation, reconciliation, and audit support to ensure report accuracy and compliance readiness.
• Collaborate with Utilization Management (UM) and Care Management (CM) teams to refine reporting requirements.
• Work with multiple data sources including core administrative systems and UM platforms.
• Support reporting submission cycles, including pre-validation, issue resolution, and final deliverables.
• Ensure compliance with regulatory guidelines and internal audit controls.
• Identify opportunities to automate and optimize reporting processes.

• 5+ years of experience in the healthcare payer domain, preferably in Medicare Advantage.
• Hands‑on experience with Medical Management compliance reporting (ODAG, CDAG, and related regulatory reporting).
• Strong understanding of Utilization Management (UM) and Care Management (CM) workflows.
• Experience working with healthcare data models and regulatory datasets.
• Proficiency in SQL, data analysis, and reporting tools.
• Experience with systems such as MHK (MedHOK) and core administrative platforms (e.g., IKA, QNXT, Facets, or similar).
• Experience with data validation, reconciliation, and audit processes.
• Strong analytical, problem‑solving, and communication skills.

• Experience supporting CMS audits and compliance submissions.
• Exposure to Azure-based data environments or modern data platforms.
• Knowledge of EDI transactions (837/835) and claims lifecycle.
• Experience with automation and reporting optimization initiatives.