The Examiner will assist with the enforcement of federal health insurance regulations by drafting project documents and analyzing health plan records. They will synthesize findings of compliance or non-compliance and report progress to the Senior Examiner.
The Senior Compliance Examiner will perform analytical reviews and accuracy testing of MLR calculations and healthcare insurance transactions. They will also review Quality Improvement Activity expenses and Pharmacy Benefit Manager contracts to ensure compliance with state and federal regulations.
The Exam Manager oversees MLR examination work streams, manages staff examiners, and ensures all examination procedures and work papers meet federal and state standards. They are responsible for analyzing premium and claims data, providing guidance to the team, and maintaining project schedules.
The examiner will conduct PBM audits and examinations in accordance with the NAIC Market Regulation Handbook. They are also responsible for leading others and managing multiple projects with competing priorities.
