Examination Resources, LLC · 1 day ago

Senior Examiner – Pharmacy Benefit Manager (PBM) Compliance Services

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

Lead PBM audit examinations across various states and PBM entities in accordance with state requirements.

Complete PBM examination work in the required state software platform.

Interpret state rules and regulations pertaining to enforcement requirements of PBMs and related examinations thereof.

Ensure all deadlines presented by examination workplan schedule and PBM management are met.

Ability to supervise multiple examiners and workflow processes required for each PBM examination.

Strategize and collaborate with PBM leadership for program success.

Assist with PBM legal review, research, and writing.

Assist leadership in various PBM practice development activities, including strategic discussions, tasks, and partnerships.

Ability to adapt to a fast-paced environment.

Qualification

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Healthcare auditingInsurance auditingNAIC Market Regulation HandbookCertified Insurance Examiner (CIE)Market Conduct Management (MCM)Legal researchLegal writingExamination/audit skillsCPBSCPhTMicrosoft OfficeAdobe Acrobat PDF

Required

Ability to obtain the Certified Insurance Examiner (CIE), Market Conduct Management (MCM), and/or other pertinent designations relevant to the PBM industry, including continuing education requirements.

Prior healthcare and/or insurance auditing experience.

Industry PBM professionals encouraged to apply (CPBS, CPhT).

2+ year’s experience completing examinations in according with NAIC Market Regulation Handbook.

2+ years’ experience as an attorney, accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or state/Federal agency.

Experience leading others.

Exceptional legal research, writing, and verbal communication skills.

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

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

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

Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.