Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.
We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
The Clinical Regulatory Oversight Business Analysts provides analytical documentation, and reporting support from prior authorization submission through claims payment to the Clinical Regulatory Oversight team. This role supports regulatory compliance activities impacting Clinical Services including Utilization Management (UM), Appeals, and Grievances (AG) and Care Management (CM) by assisting with audit readiness, NCQA deliverables, reporting requirements, and maintenance of regulatory documentation. The Business Analyst partners closely with Program Managers and cross-functional stakeholders to ensure regulatory requirements are accurately implemented, monitored, and supported by defensible data and documentation. Performs other duties as assigned.
Key Accountabilities
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Regulatory and Audit Support
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Support internal, state, federal, and accreditation audits by gathering, organizing, and validating regulatory documentation and data.
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Maintain audit trackers, issue logs, evidence inventories, and corrective action tracking tools.
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Assist Program Managers with preparation of audit responses and follow-up materials.
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Reporting and Data Validation
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Assist with gathering State and Federal regulatory, NCQA, and internal reporting requirements that impact UM, AG and CM or operating models.
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Validate accuracy, completeness, and consistency of data across reports and source systems.
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Partner with analytics, operations, and vendors to resolve data discrepancies.
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Regulatory Implementation Support