Market Conduct Examiner (Health and PBM)

New

Work from home-any US locationFull-TimeMiddle

Salary$69,800 - $132,000

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Job Details

Experience: 5+ years
Required Skills: Project ManagementData AnalysisMicrosoft ExcelRisk Management

Bachelor’s Degree in Business, Risk Management, Accounting or Finance.
Minimum of 5+ years insurance experience with a State/Federal agency, insurance company, examination firm, or public accounting firm.
Demonstrated experience as an internal or external auditor, adjuster, compliance professional, or examiner.
Professional insurance designations such as AIE/CIE, MCM, AIRC, FLMI, CPCU, or CLU (or currently pursuing).
Skilled in using software for presentations, spreadsheets, and project planning (TeamMate, ACL/Access, MS Excel, Word, and Power Point).
Demonstrated history of project management experience.
Ability to interact with all levels of the organization including executives and senior managers.
Strong interpersonal, presentation, analytical, and examination/audit skills.
Excellent organizational and time management skills.
Ability to adapt to a fast-paced environment and work independently.
Willingness for minimal travel.

Perform comprehensive, targeted and risk focused market conduct examinations to determine compliance with states’ insurance statutes and regulations.
Review and assess insurance company’s documentation and data to determine compliance with insurance regulations.
Draft examination work papers and assist with the preparation of reports and exhibits detailing compliance.
Review and analyze proposed or revised laws, regulations, and policies to determine their impact on insurance companies.
Analyze reports relating to pharmacy audits conducted by PBMs, including spread pricing, reimbursement, and network adequacy.
Complete examination work using the required state software platform, including TeamMate+.

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