Examiner, Market Conduct

About the role

A growing team is seeking a motivated and skilled Examiner with health insurance  and health care industry knowledge to assist with the enforcement of federal health insurance regulations such as the No Surprises Act (NSA), Transparency in Coverage, and others. The Examiner will be an integral part of the market conduct examinations team and will assist with regulator enforcement of federal regulations. This is a unique opportunity to be part of a highly important and visible project transforming the American healthcare landscape for years to come. Professionals possessing intellectual curiosity, initiative, and interest in growing their careers are encouraged to apply.

What you'll do

• Draft documents necessary for completing projects, such as requests for information (RFIs); criticisms (conclusions of non-compliance) and rebuttals to criticism responses; audit outlines and flow charts; internal communications, etc.
• Organize and analyze RFIs production, responses to criticisms, correspondence, and other project-related items.
• Review and analyze health plan and issuer records, including data and claim files.
• Synthesize results of the records analysis, applying regulations to demonstrate findings of compliance or non-compliance.
• Complete assigned tasks in a timely and accurate manner.
• Communicate with and report to the Senior Examiner regarding project progress.
• Adapt and implement changes to projects based on team needs.
• Perform job duties within a matrix management structure.

Qualifications

• Bachelor’s degree or equivalent experience in health insurance or health care Compliance, Audit, or insurance operations
• 2+ years of insurance regulatory, compliance, or audit experience
• Experience reading and interpreting federal and state regulations
• Ability to obtain either the MCM or AIE designation issued by Insurance Regulatory Examiners Society (IRES) within 6 months of hire
• Critical thinking skills and ability to determine appropriate courses of action
• Excellent time management skills
• Ability to manage multiple projects, tasks, and changing priorities efficiently
• Excellent written and oral communication
• Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF and the ability to learn and apply new software programs
• Ability to perform equally as well when working independently or with a team
• Self-motivated and ability to complete tasks with minimal direction

Standout Skills

•  Insurance industry designations such as Market Conduct Management (MCM), Accredited Insurance Examiner (AIE), and/or Certified Insurance Examiner (CIE)
• Auditing background
• Curious mindset
• Excellent Writing
• Strong Communication Skills

Benefits

• 401(k) and match
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Paid time off
• PTO Bonus
• Reimbursement towards professional development, phone, and gym membership