Health Insurance Senior Examiner Position

4 weeks ago


Tampa, Florida, United States StrategyGen Co Full time
Job Description

StrategyGen Co is seeking a highly skilled Health Insurance Senior Examiner to join our team. As a Senior Examiner, you will be responsible for evaluating health insurance issuers' compliance with state and federal laws and regulations.

Key Responsibilities:

  • Evaluate health insurance issuers' compliance with state and federal laws and regulations.
  • Conduct onsite or desk audits, compliance and form filing reviews, market conduct examinations, and regulatory investigations.
  • Collaborate with the Examiner-in-Charge, Project Task Lead, and other project team members to develop, prioritize, and execute assigned market conduct activities.
  • Identify necessary information and methodology, including required documents and data sample sizes, and prepare work plans for market conduct examinations.
  • Collect and objectively analyze issuer 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.
  • Lead a group of examiners in conducting plan document reviews, market conduct examinations, investigations, and/or audits.
  • Perform reporting and signing of market conduct examinations and audits, and ensure accurate entry into TeamMate Plus and other applicable databases.

Requirements:

  • Bachelor's degree from an accredited college/university, plus 5 years of professional experience.
  • Significant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigation.
  • 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.
  • Certified Insurance Examiner (CIE) designation from the Insurance Regulatory Examiners Society, and Market Conduct Management (MCM) designation.
  • Extensive knowledge of state and federal laws and regulations pertaining to the Affordable Care Act, Mental Health Parity and Addiction Equity Act, and No Surprises Act, health insurance, and/or healthcare services.
  • Strong project management, organizational, communication, and writing skills, with the ability to change priorities quickly, handle multiple tasks simultaneously, and meet deadlines.

About StrategyGen Co:

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 PhDs. Our vision is to improve the health of healthcare for good. We create long-term partnerships and relationships, and provide the customer with deliverables of the highest quality.


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