Senior Advisor, Market Conduct (PBM/Health Plan)
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Assists with and, as appropriate, takes the lead to facilitate examination activity for MCE issues involving Express Scripts and its affiliated entities as well as EviCore. Partners with other market conduct team members and, as appropriate, takes the lead on examinations to manage requests for information, facilitate responses to requests with business partners, and establish and maintain contacts with key business partners and Department of Insurance and other regulatory examiners. Work in partnership with other market conduct team members to address and/or receive guidance on addressing findings and corrective action plans with business partners and to facilitate resolution of the exam and any proposed fines or penalties.
Key Responsibilities:
- Act as Company coordinator for market conduct examinations.
- Serve as liaison to insurance department examiners during the examination process.
- Assess market conduct issues and findings, communicate company position statements, develop appropriate responses and corrective actions, and work with Managing Counsel to negotiate outcomes to mitigate risk for the Cigna companies.
- Collaborate with business partners, including Legal, Regulatory, Account Management, PBM Operations, EviCore and others to ensure MCEs are conducted efficiently.
- Complete all pre-examination surveys, data requirements and examination materials in an accurate and timely manner.
- Provide responses to examiner requests and criticisms within stated/negotiated timeframes. Utilize Open Pages, iManage and/or other tools, as appropriate.
- Act as an advisor/consultant to business partners regarding regulatory examinations.
- Communicate market conduct issues and findings, company position statements, and best practices to Legal and business partners.
- Assist in the development of practices to address issues and to close compliance gaps and mitigate risk.
- Develop business partner relationships to assist in fostering a compliant and efficient environment with mutual ownership.
- Assist business partners by providing direction and instruction in responding to MCE requests
Qualifications and Skills:
Bachelor’s degree or equivalent experience
Minimum 5+ years of regulatory, compliance, or market conduct experience within health insurance, PBM, or utilization management (UM)
Experience supporting or managing market conduct examinations (MCEs) or working directly with Department of Insurance (DOI) regulators and exam processes
Demonstrated ability to manage regulatory examinations, including coordinating responses, analyzing findings, and supporting corrective action plans
Strong knowledge of PBM and/or UM operations, regulatory frameworks, and business processes
Proven ability to manage complex, regulator-facing matters and drive outcomes
Excellent written and verbal communication skills, with the ability to present company positions to regulators and internal stakeholders
Strong organizational skills with the ability to manage multiple deadlines, requests, and stakeholders simultaneously in a matrixed environment
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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