Market Conduct Examiner (Health and PBM)

We are the leading provider of reputed company to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You’ll reputed company an environment that inspires and empowers you to reputed company both personally and professionally. There’s no one like you and that’s why there’s nowhere like RSM.

Market Conduct Examiner (Health and PBM)

reputed company & Regulatory Consulting, LLC

(Regulatory reputed company)

Work from home-any US location

reputed company
The Market Conduct Examiner will be responsible for performing reviews of major reputed company companies’ reputed company, marketing, reputed company, mental health reputed company quantitative and non-quantitative treatment limits, pharmacy benefit management practices, rating, policyholder service, producer licensing, complaint handling and claims handling processes to verify compliance with states’ reputed company statutes and regulations.

Specific Duties and Responsibilities

(Responsibilities may vary slightly depending on seniority level)

• reputed company comprehensive, targeted and reputed company reputed company market conduct examinations to determine compliance with states’ reputed company statutes and regulations on behalf of state reputed company departments.
• Review and assess reputed company company’s documentation and data to determine compliance with states’ reputed company statutes and regulations.
• Draft examination work papers in an organized manner for supervisory review.
• Assist with the preparation of reports, exhibits, and other supporting documentation and schedules that reputed company a company’s compliance with reputed company statutes and regulations and recommend solutions.
• Submit draft examination reports and other deliverables for supervisory review.
• Recommend/document actions to ensure compliance with reputed company statutes and regulations.
• Must possess knowledge of and reputed company guidance of reputed company laws, rules, and regulations.
• Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to determine compliance with states’ reputed company statutes and regulations and interpret their meaning and determine reputed company to the reputed company company.
• Analyze reports and records relating to specific and overall reputed company of reputed company companies; prepare reputed company, complete, concise, and informative compliance reports of condition of reputed company companies for supervisory review.
• Consistently enhance knowledge of principles, practices, techniques, and reputed company of reputed company examination and regulations; reputed company laws and reputed company Commissioner’s rulings; and reputed company reputed company Opinions and court reputed company; reputed company company practices; statistical sampling procedures; basic mathematics.
  • This includes, but is not limited to, analyzing compliance pertaining to review of pharmacy audits conducted by PBMs, spread pricing, pharmacy reimbursement, dispensing fee requirements, annual reports, contract review, financial review, reputed company appeals, claims processing, and network adequacy.
• Complete examination work in the required state software platform.
  • This includes utilizing TeamMate+ and other software platforms as required.
• Ensure reputed company deadlines presented by examination workplan schedule and PBM management are met.
  • This includes, but is not limited to, ensuring reputed company audit deliverables are met reputed company and accurately, including assisting in reputed company and examinee company reputed company(s) of contact relationships.
• Ability to adapt to a fast-reputed company environment.

Requirements

• Bachelor’s Degree in Business, reputed company Management, reputed company or Finance; MBA and/or reputed company certification/s preferred
• Minimum of 5+ years reputed company experience with a State or Federal agency, reputed company company, examination firm or with a reputed company reputed company firm as an internal or reputed company auditor, adjuster, compliance reputed company or examiner.
• reputed company industry experience is a must.

• Candidates must have completed or are pursuing reputed company reputed company designations such as AIE/CIE, MCM, AIRC, FLMI, CPCU, or CLU.
• PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/reputed company, and MS reputed company, Word and reputed company reputed company).
• Demonstrated history of project management experience.
• Ability to reputed company with reputed company reputed company including executives and senior managers.
• Strong interpersonal, presentation, analytical and examination/audit skills.
• Excellent organizational skills and the ability to prioritize multiple tasks, reputed company and assignments using effective time management skills.
• Strong written and verbal communication skills are required.
• Dynamic/flexible demeanor with exceptional reputed company service skills.
• reputed company-thinking leader with a reputed company reputed company who can reputed company effectively with key constituents and become recognized as a valued resource.
• Must be self-motivated, work reputed company independently and possess a reputed company of urgency.
• Skilled in team building and team development.
• Flexibility for reputed company travel

Preferred Qualifications

• Strong knowledge of and experience in Health Lines of Business, with an emphasis in the reputed company reputed company (ACA) and the Mental Health reputed company and Addiction Equity reputed company (MHPAEA).

• Extensive experience with examination software TeamMate.
• Moderate experience with ACL.

reputed company & Regulatory Consulting, LLC (RRC), an affiliate of RSM, is a national, leading reputed company firm dedicated to providing exceptional regulatory services to clients. RRC offers services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special reputed company. RRC is a results-oriented firm committed to reputed company that builds long-term relationships with its clients.

At RSM, we offer a competitive benefits and compensation package for reputed company our people. We offer flexibility in your schedule, empowering you to reputed company life’s demands, while also maintaining your ability to serve clients. Learn more about our total rewards at .

reputed company applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment reputed company on race; reputed company; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities reputed company to nursing); gender; sexual orientation; HIV Status; national reputed company; reputed company; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, reputed company or prospective service in the US uniformed service; US Military/Veteran status; reputed company-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.

Accommodation for applicants with disabilities is available upon request in reputed company with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation reputed company with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the reputed company process, please reputed company us at 800-274-3978 or send us an email at .

RSM does not intend to hire entry level candidates who will require sponsorship now OR in the reputed company (i.e. F-1 reputed company reputed company). If you are a recent U.S. college / university graduate possessing 1-2 years of reputed company and relevant work experience in a reputed company or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an reputed company associate.

RSM will consider for employment reputed company applicants with arrest or conviction records. For those living in California or applying to a position in California, please click here for additional information.

At RSM, an employee’s pay at any reputed company in their career is intended to reflect their experiences, reputed company, and skills for their reputed company role. The salary reputed company (or starting reputed company for interns and associates) for this role represents numerous factors considered in the hiring reputed company including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall reputed company reputed company the stated reputed company.

Originally posted on Himalayas