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Health Insurance Examiner

2 months ago

Jacksonville, United States STRATEGYGEN CO Full time $70,000 - $90,000
Job DescriptionJob DescriptionStrategyGen is seeking experienced Health Insurance Examiner(s) to join our team This is a full-time remote position, with limited travel. StrategyGen offers competitive compensation, a generous benefits package, flexible schedules, and a collaborative work environment. 

Job Summary The Health Insurance Examiner is responsible for performing multiple tasks and market conduct activities to evaluate health insurance issuers (Issuers) compliance with state and federal laws and regulations, such as the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA). Market conduct activities may include onsite or desk audits, compliance and form filing reviews, market conduct examinations, and regulatory investigations.  

Candidates for this position must have extensive knowledge and experience in the health insurance sector, hold the Market Conduct Management (MCM) designation, and possess strong communication and interpersonal skills with the ability to work independently and collaboratively with cross-functional teams, key stakeholders, senior leaders and clients. Additionally, candidates should have excellent analytical, organizational and project management skills with the ability to prioritize multiple tasks and adapt to changing priorities to ensure delivery of high-quality, on time and within budget work products and deliverables. 

Responsibilities/Duties: 
  • Collaborate with the senior examiners, Examiner-in-Charge (EIC) and review team to develop, prioritize and execute assigned market conduct activities, provide regular updates and escalate risks and issues to the EIC and Project Officer 
  • Assist in preparing requests for information to Issuers, and/or with preparing work plans for each market conduct examination, as applicable 
  • Collect and objectively analyze Issuers records, files, and data to evaluate compliance with state and federal laws, regulations and requirements 
  • Document findings, prepare and submit workpapers and other deliverables for supervisory review that include the procedures performed, conclusions reached and supporting documentation for findings that are not in compliance or where errors are identified
  • Assist with preparing draft reports, exhibits and supporting documentation that contain detailed examination findings and recommendations for appropriate actions
  • Perform research and analysis of regulatory updates and guidance issued by CCIIO to Issuers to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulations
  • Review and support the update of examination protocols when new regulations are released to ensure that they reflect the latest information
  • Serve as a subject matter expert (SME) and as a resource and mentor to other staff
  • Perform other duties as assigned
Education and Experience: 
  • Bachelor's degree from an accredited college plus 1 - 2 years of relevant experience 
  • Significant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigation
  • Must hold the Market Conduct Management (MCM) designation from the Insurance Regulatory Examiners Society
  • Accredited Insurance Examiner (AIE) designation - a plus
Specific Knowledge and Skills: 
  • Extensive knowledge of state and federal laws and regulations pertaining to the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA), health insurance, and/or healthcare services
  • In-depth knowledge of standards and processes in the NAIC’s Market Regulation Handbook; knowledge of health care laws and regulations (HIPAA, ERISA) a plus
  • Strong project management, organizational, communication and writing skills, with the ability to change priorities quickly, handle multiple tasks simultaneously and meet deadlines
  • Excellent interpersonal skills, with the ability to build strong working relationships, give and follow instructions accurately and efficiently while being proactive in asking clarifying questions to ensure work effort is directed toward desired outcome
  • High-level attention to detail
  • Intermediate level computer skills; MS Outlook, Excel, Word, Adobe, PowerPoint as well as general knowledge of data base programs and spreadsheet options; TeamMate Plus software experience desired