Market Conduct Examiner – Health and PBM

🕒 May 30

🇺🇸 United States – Remote

💵 $95.4k - $192k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 45%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 167 days.
• Jobs at this company usually fill in 21 days.
• Reposted once.

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RSM US LLP

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1926

💼 Consulting

Consulting • Financial services • Professional services

RSM US LLP is a limited liability partnership and the U. S. member firm of RSM International, providing assurance, tax, and consulting services primarily to middle market businesses. The firm focuses on delivering insights and tailored solutions to help clients navigate complex business challenges and drive growth. With expertise across various sectors, RSM aims to support client success through strategic consulting and practical business solutions.

📋 Description

• Perform comprehensive, targeted, and risk-focused market conduct examinations for state insurance departments • Review major insurance companies’ operations, marketing, underwriting, mental health parity treatment limits, pharmacy benefit management practices, rating, policyholder service, producer licensing, complaints, and claims processes • Review and assess insurance company documentation and data for regulatory compliance • Draft examination work papers for supervisory review • Assist with reports, exhibits, supporting documentation, and schedules detailing compliance and recommended solutions • Submit draft examination reports and deliverables for supervisory review • Recommend and document actions to ensure compliance with insurance statutes and regulations • Provide guidance on insurance laws, rules, and regulations • Review proposed and revised laws, regulations, policies, and procedures and assess their impact • Analyze insurance company reports and records and prepare compliance reports • Analyze PBM pharmacy audits, spread pricing, pharmacy reimbursement, dispensing fees, annual reports, contracts, financial reviews, appeals, claims processing, and network adequacy • Complete examination work in TeamMate+ and other required state software platforms • Meet examination workplan and PBM management deadlines • Assist with client and examinee company point-of-contact relationships

🎯 Requirements

• Bachelor’s Degree in Business, Risk Management, Accounting or Finance • Minimum of 5+ years insurance experience with a State or Federal agency, insurance company, examination firm or public accounting firm as an internal or external auditor, adjuster, compliance professional or examiner • Insurance industry experience is required • Completed or pursuing professional insurance designations such as AIE/CIE, MCM, AIRC, FLMI, CPCU, or CLU • PC skills, including presentation, spreadsheet, and project planning software • Experience with TeamMate, ACL/Access, and MS Excel, Word and PowerPoint • Demonstrated project management experience • Ability to interact with executives and senior managers • Strong interpersonal, presentation, analytical, and examination/audit skills • Excellent organizational skills and ability to prioritize multiple tasks and projects • Strong written and verbal communication skills • Dynamic/flexible demeanor with exceptional client service skills • Self-motivated, able to work independently, and able to work with urgency • Skilled in team building and team development • Flexibility for minimal travel • Preferred: strong knowledge and experience in Health Lines of Business, ACA, and MHPAEA • Preferred: extensive experience with TeamMate • Preferred: moderate experience with ACL

🏖️ Benefits

• Competitive benefits and compensation package • Discretionary bonus based on firm and individual performance • Flexible work arrangements, including virtual or primarily on-site workstyles depending on role requirements • Reasonable accommodation for applicants with disabilities

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