Exam Manager – MLR Exams

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Examination Resources, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2002

💼 Consulting

🛡️ Insurance

🏛️ Government

Consulting • Insurance • Government

Examination Resources, LLC is a woman-owned regulatory consulting firm (WOSB) that delivers specialized, regulator-only consulting services to state and federal insurance regulators across the U. S. Since 2002, ER has focused on insurance oversight and consumer protection, offering actuarial and financial analysis, financial examinations, health consulting, IT consulting, market conduct reviews, MLR and PBM compliance, receivership and other specialized regulatory services. The firm emphasizes avoidance of conflicts of interest by serving only regulators, is an approved GSA vendor, and highlights a track record of 2,500+ projects, 160+ focused talent, and support for 45+ regulators.

📋 Description

• Ensure successful completion of comprehensive Medical Loss Ratio (MLR) examinations in accordance with CCIIO procedures and processes • Oversee work streams and staff examiners and maintain the exam/project schedule • Manage interactions and communications with examinee company points of contact • Supervise multiple examiners and provide guidance and assistance as needed • Complete MLR examination procedures to supplement other staff's work as necessary • Perform detailed reviews of examination work papers for accuracy, organization, and compliance with federal and state government client expectations • Provide performance input for supervised examiners • Manage analysis of premium and claims data using ACL to select samples, extract information, and create reports • Obtain required continuing education for credentials and designations • Adapt to a fast-paced environment

🎯 Requirements

• Experience with MLR or healthcare insurance auditing or accounting required • Prior audit/examination management experience required • Bachelor's Degree in Accounting or Finance is preferred, but not required • Ability to obtain CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) designations • 3+ 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 MLR related audits • Experience leading others • In-depth knowledge of the NAIC's Accounting and Practices and Procedures Manual • Exceptional written and verbal communication skills • Strong interpersonal, presentation, analytical and examination/audit skills • Excellent organizational skills and ability to prioritize multiple tasks, projects and assignments using effective time management skills • Must be self-motivated, work well independently and possess a sense of urgency • Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF • Experience interpreting output from Audit Command Language (ACL), Tableau, or similar data mining tools is a plus, highly desired experience

🏖️ Benefits

• Fully remote work • No travel required • Continuing education, as required, for all credentials and required designations