Health Insurance Senior Examiner Position

4 weeks ago


Jacksonville, Florida, United States STRATEGYGEN CO Full time
Job Overview

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.
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 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.
Preferred 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).
  • 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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