Regulatory Reporting Analyst

ProCare Rx; Gainesville (GA); Hybrid; USD 70,000 - 100,000; Full time

Job summary

ProCare Rx is seeking an experienced regulatory reporting analyst to join our compliance team. You will monitor state and federal filing obligations and coordinate with Legal, Rebates, and Finance to translate regulations into reporting specifications.

You will build SQL queries, validate data, and ensure on-time submissions for CMS, URAC, and other regulators while maintaining documentation and supporting audits.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Information Systems, or related field.
• 2+ years of experience in regulatory reporting, compliance, or data analysis in healthcare payer environments.
• SQL proficiency required to write and troubleshoot complex queries against large claims and eligibility datasets.
• Working knowledge of PBM operations and terminology (claims adjudication, eligibility, formulary, rebates).
• Strong attention to detail with ability to manage multiple deadlines across states and agencies.
• Excellent written and verbal communication, including explaining regulatory and technical concepts to non-technical stakeholders.
• Proficiency with Excel for data validation and ad hoc analysis.

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 required annual 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.”],
• CoT_job_summary_short:

Skills

SQL proficiency

PBM operations knowledge

Attention to detail

Communication skills

Excel

Education

Bachelor's degree in Healthcare Administration, Business, Finance, IS

Tools

Power BI

QlikView

Tableau

Job description

• 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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.