Medicaid Regulatory Analyst & Implementation Lead

Triple-S; Guaynabo (PR); On-site; USD 70,000 - 100,000; Full time

Job summary

Triple-S is seeking a Medicaid Analyst to support the Medicaid Market Office by analyzing contract provisions, ASES circulars, and regulatory guidance, translating them into practical operational steps for our teams.

This role bridges strategy, operations and compliance, ensuring timely interpretation, coordinating timelines, and providing leadership with clear implementation guidance on regulatory initiatives.

Qualifications

• Bachelor's degree in Business Administration or Public Health.
• 4–7 years of experience in Medicaid, healthcare operations, regulatory analysis, or related highly regulated environments.
• Project Management certification recommended but not required.

Responsibilities

• Analyze and interpret Medicaid contract provisions, ASES circulars, guidance, and regulatory requirements; translate requirements into practical operational implications.
• Support implementation of regulatory and contractual initiatives by coordinating timelines, dependencies, and deliverables across functions.
• Prepare draft responses, summaries, and implementation guidance related to contractual or regulatory inquiries for leadership review.
• Serve as first-level analytical filter for routine regulatory and contractual inquiries, escalating higher-risk issues to Compliance or Legal as appropriate.
• Monitor regulatory developments and assess potential operational, financial, and compliance impacts to the Medicaid business.
• Track implementation progress, risks, and recurring inquiry trends; provide leadership visibility to support decision-making.
• Support process documentation, playbooks, and reference materials to promote consistency and efficiency in regulatory interpretation and implementation.

Skills

Action Oriented

Collaborates

Customer Delight (Employee)

Instills Trust

Manages Ambiguity

Education

Bachelor's degree in Business Administration or Public Health

Job description

Triple-S is seeking a Medicaid Analyst to support the Medicaid Market Office by analyzing contract provisions, ASES circulars, and regulatory guidance, translating them into practical operational steps for our teams.

This role bridges strategy, operations and compliance, ensuring timely interpretation, coordinating timelines, and providing leadership with clear implementation guidance on regulatory initiatives.