Health Insurance Senior Examiner Position
4 weeks ago
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- Collaborate with project teams to develop and execute market conduct activities, providing regular updates and escalating risks and issues as needed.
- Collect and analyze issuer records, files, and data to evaluate compliance with state and federal laws and regulations.
- Document findings, prepare workpapers, and submit deliverables for supervisory review.
- Prepare and assist with preparing draft reports, exhibits, and supporting documentation.
- Lead project teams in conducting plan document reviews, market conduct examinations, investigations, and audits.
- Conduct entrance and exit conferences with examined companies.
- Manage research and analysis of regulatory updates and guidance issued by CCIIO.
- Review and support the update of examination protocols.
- Serve as a Subject Matter Expert and resource for other staff.
- 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 MCEs 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, as well as the Market Conduct Management (MCM) designation.
- 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).
- Strong project management, organizational, communication, and writing skills.
- Excellent interpersonal skills, with the ability to build strong working relationships.
- High-level attention to detail.
- Proficiency with MS Outlook, Excel, Word, Adobe, PowerPoint, and TeamMate Plus software.
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