Medicaid Senior Consultant

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

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Job Summary

Supports the Medicaid Market Office by providing first-level analysis, interpretation, and execution support related to Medicaid contractual, regulatory, and policy requirements. The role serves as a business-unit-level integrator between strategy, operations, and compliance, ensuring timely, accurate interpretation of ASES guidance and effective implementation of regulatory and strategic initiatives. This position enhances organizational capacity to manage regulatory complexity while protecting leadership bandwidth for strategic planning and external engagement.

Essential Functions

• 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 (e.g., payment model changes, reporting requirements) 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 or policy-level 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 visibility to leadership to support decision-making and prioritization
• Support process documentation, playbooks, and reference materials to promote consistency and efficiency in regulatory interpretation and implementation.

EDUCATION

• Bachelor's Degree in Business Administration or Public Health

Experience

• Bachelor’s degree in Business Administration, Health Administration, Public Health, Public Policy, Law (non‑litigative), or a related field. Minimum 4–7 years of experience in Medicaid, healthcare operations, regulatory analysis, or related highly regulated environments.
• Project Management certification recommended but not required.

LICENSES AND CERTIFICATIONS

• PMP - Project Management Professional (preferable)

COMPETENCIES

• Action Oriented
• Collaborates
• Customer Delight (Employee)
• Instills Trust
• Manages Ambiguity

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug‑free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E‑Verify to verify the eligibility of employment of all the new employees.