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Health Insurance Senior Examiner

2 months ago

Jacksonville, United States StrategyGen Co Full time

StrategyGen is seeking experienced Health Insurance Senior Examiners to join our team The Senior Examiner is responsible for conducting compliance reviews, insurance market conduct examinations, audits and regulatory investigations under the Affordable Care Act (ACA) regulation. Additionally, one or more of these position(s) will serve as lead examiner(s) for successful execution of the Mental Health Parity and Addiction Equity Act (MHPAEA) non-quantitative treatment limitation (NQTL) analysis audits.

Candidates for this position must have experience in performing and leading market conduct examinations and MPHAEA NQTL analysis audits, hold the Certified Insurance Examiner (CIE) designation and have in-depth knowledge of standards and processes in the NAIC's Market Regulation Handbook. The ability to work under minimal supervision while delivering high-quality products on time and on budget is vital for this position. As such, the candidate should possess good time management, prioritization, communication and interpersonal skills, and the ability to work cohesively with the team and follow the lead of the Examiner-in-Charge and Program Director/Project Officer.

StrategyGen offers competitive compensation, flexible schedules, a collaborative work environment and highly qualified leadership to assist our team. This is a remote full-time position, however there may be periodic limited travel involved.

Responsibilities/Duties:

  • Develop and prioritize the review schedule and levels of effort to ensure timely completion of exams/audits/reviews
  • Perform research and analysis of regulatory updates and guidance issued by CCIIO to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulations
  • As lead examiner, assign, oversee and direct MPHAEA NQTL analysis audit team in performing audits, investigations, reviews and market conduct examinations
  • Document the research and analysis that has been completed and provide supporting documentation for Findings, specifically documenting how operational areas are not in compliance or where errors are identified
  • Use audit software (TeamMate Plus) by completing all required sections and all work within the appropriate work areas
  • Prepare draft report and exhibits to summarize all Findings
  • Modify audit software to accurately reflect the report as issued after edits have been incorporated
  • Create and maintain project deliverables and reports to support contractual and regulatory compliance
  • 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, and as a resource and mentor for other staff
  • Perform other duties as assigned
Education & Experience:
  • Bachelor's degree in a related field plus 5 years of professional experience
  • At least three (3) years of progressive professional work experience as an insurance auditor, including conducting market conduct examinations and MPHAEA NQTL analysis audits and in a leadership or management role overseeing and conducting examinations, investigations and/or audits
  • Must hold the Certified Insurance Examiner (CIE) designation from the Insurance Regulatory Examiners Society
  • Market Conduct Management (MCM) insurance designation
  • In-depth knowledge of standards and processes in the NAIC's Market Regulation Handbook
  • Intermediate level computer skills; MS Outlook, Internet Explorer, Excel, Word, Adobe, PowerPoint as well as general knowledge of data base programs and spreadsheet options
  • TeamMate Plus software experience desired
Specific Knowledge & Skills:
  • Extensive knowledge of Local, State, and Federal laws and regulations pertaining to the Affordable Care Act (ACA), health insurance, and/or healthcare services
  • Knowledge of health care laws and regulations (HIPAA, ERISA) a plus
  • Significant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigation
  • 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 within the audit team and cross-functionally
  • Strong understanding and commitment to professional auditing standards
  • High-level attention to detail
This is a remote position.

About StrategyGen

Empowering Decisions with Precision and Insights

StrategyGen was founded in 2009 and received its SBA HUBZone small business certification in 2021. We are a unique and differentiated HUBZone small business that provides highly specialized policy and regulatory specialists, market researchers, healthcare professionals, physicians, clinicians, and SME PhD's.

StrategyGen's Mission

Our Mission is to exceed our clients' expectations by providing innovative, pragmatic and cost-effective solutions for their most complex problems.

Vision

Our Vision is to improve the health of healthcare for good.

Values
  • Act with the highest integrity and ethics.
  • Focus on collaboration.
  • Create long-term partnerships and relationships.
  • Approach change as an exciting opportunity.
  • Provide the customer with deliverables of the highest quality.
  • Be proactive and exceed expectations.
  • Respect and value others.
  • Accept responsibility.
  • Lead with care, compassion, and empathy.