Senior Compliance Examiner/Auditor – 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

• Perform analytical reviews of documentation supporting MLR calculations and rebate distributions for compliance with state and federal legislation • Perform attribute and accuracy testing of premium, claims, and other MLR calculation transactions • Review Quality Improvement Activity expenses and intercompany allocations • Review Pharmacy Benefit Manager contracts and prescription drug claims data for compliance with applicable laws and regulations • Interpret MLR regulations, filing instructions, and technical guidance against company documentation • Write or supervise written documentation of clear, concise examination conclusions • Assist with or lead internal MLR training and audit procedure creation

🎯 Requirements

• Experience with MLR or healthcare insurance auditing or accounting required • Minimum 2+ years’ experience as an accountant, auditor, examiner, or analyst with a state insurance department, public accounting firm, insurance company, or related entity involved in MLR audits • Bachelor's Degree in Accounting or Finance preferred, but not required • CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) preferred, but not required • PC skills, including presentation, spreadsheet, and project-planning software • Skilled in TeamMate, ACL/Access/Tableau, and MS Excel, Word, and PowerPoint • Strong interpersonal, presentation, analytical, and examination/audit skills • Excellent organizational skills and ability to prioritize multiple tasks using effective time management • Strong written and verbal communication skills • Dynamic and flexible demeanor with exceptional customer service skills • Self-motivated, able to work independently, and able to demonstrate urgency • Ability to demonstrate ethical and professional standards outlined by the firm