Examination Resources, LLC · 1 day ago

Senior Compliance Examiner

United States

Full-time

Remote

Mid, Senior Level

2+ years exp

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Financial ServicesInsurance

Hiring Manager

Erika Samuelian

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Responsibilities

Perform reviews of documentation provided by companies supporting MA/PD MLR calculations and distribution of remittances to the federal government.

Perform attribute and accuracy testing of policy and claims transactions, and other major components of the MA/PD MLR calculation to determine completeness and accuracy.

Review costs for activities that improve the quality of care provided to MA/PD members, ensuring reported costs meet the required definition for inclusion in the MLR calculation, and that intercompany allocations are fair and reasonable.

Interpret MA/PD MLR regulations, filing instructions and technical guidance in comparison to documentation provided by MA Organizations and PD Plan Sponsors.

Prepare and/or supervise others in the documentation of clear, concise, and informative conclusions on required MA/PD MLR examination procedures.

Assist and lead in the creation of internal MA/PD MLR trainings and audit procedure creation.

Qualification

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Medicare auditingMedicaid auditingMLR complianceAccountingPublic accountingInsurance auditingCPACIACFEAFEExcelPowerPointWordTeamMateACL/Access/Tableau

Required

Experience with Medicare and/or Medicaid auditing or accounting is highly desired.

Minimum 2+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or other entity involved in conducting Medicare/Medicaid related audits.

PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access/Tableau, and MS Excel, Word and PowerPoint).

Strong interpersonal, presentation, analytical and examination/audit skills.

Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills.

Strong written and verbal communication skills.

Dynamic/flexible demeanor with exceptional customer service skills.

Must be self-motivated, work well independently and possess a sense of urgency.

Ability to demonstrate ethical and professional standards as outlined by the Firm.

Preferred

Bachelor's Degree in Accounting or Finance is preferred, but not required.

CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) preferred, but not required.

Experience with MLR and related rebate/remittance requirements or accounting/auditing in the healthcare, insurance, banking, and Pharmacy Benefit Management (PBM) industries a plus, but not required.