StrategyGen Co
Health Insurance Examiner
StrategyGen Co, Jacksonville, Florida, United States, 32290
Benefits:401(k) matchingCompetitive salaryDental insuranceFlexible scheduleHealth insurancePaid time offTraining & developmentVision insuranceStrategyGen is seeking experienced Health Insurance Examiner(s) to join our team! This is a full-time remote position, with limited travel. StrategyGen offers competitive compensation, a generous benefits package, flexible schedules, and a collaborative work environment.
Job Summary
The Health Insurance Examiner is responsible for performing multiple tasks and market conduct activities to evaluate health insurance issuers (Issuers) compliance with state and federal laws and regulations, such as the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA). Market conduct activities may include onsite or desk audits, compliance and form filing reviews, market conduct examinations, and regulatory investigations.
Candidates for this position must have extensive knowledge and experience in the health insurance sector, hold the Market Conduct Management (MCM) designation, and possess strong communication and interpersonal skills with the ability to work independently and collaboratively with cross-functional teams, key stakeholders, senior leaders and clients. Additionally, candidates should have excellent analytical, organizational and project management skills with the ability to prioritize multiple tasks and adapt to changing priorities to ensure delivery of high-quality, on time and within budget work products and deliverables.
Responsibilities/Duties:
Collaborate with the senior examiners, Examiner-in-Charge (EIC) and review team to develop, prioritize and execute assigned market conduct activities, provide regular updates and escalate risks and issues to the EIC and Project OfficerAssist in preparing requests for information to Issuers, and/or with preparing work plans for each market conduct examination, as applicableCollect and objectively analyze Issuers records, files, and data to evaluate compliance with state and federal laws, regulations and requirementsDocument findings, prepare and submit workpapers and other deliverables for supervisory review that include the procedures performed, conclusions reached and supporting documentation for findings that are not in compliance or where errors are identifiedAssist with preparing draft reports, exhibits and supporting documentation that contain detailed examination findings and recommendations for appropriate actionsPerform research and analysis of regulatory updates and guidance issued by CCIIO to Issuers to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulationsReview and support the update of examination protocols when new regulations are released to ensure that they reflect the latest informationServe as a subject matter expert (SME) and as a resource and mentor to other staffPerform other duties as assignedEducation and Experience:
Bachelor's degree from an accredited college plus 1 - 2 years of relevant experienceSignificant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigationMust hold the Market Conduct Management (MCM) designation from the Insurance Regulatory Examiners SocietyAccredited Insurance Examiner (AIE) designation - a plusSpecific Knowledge and Skills:
Extensive knowledge of state and federal laws and regulations pertaining to the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA), health insurance, and/or healthcare servicesIn-depth knowledge of standards and processes in the NAIC's Market Regulation Handbook; knowledge of health care laws and regulations (HIPAA, ERISA) a plusStrong project management, organizational, communication and writing skills, with the ability to change priorities quickly, handle multiple tasks simultaneously and meet deadlinesExcellent interpersonal skills, with the ability to build strong working relationships, give and follow instructions accurately and efficiently while being proactive in asking clarifying questions to ensure work effort is directed toward desired outcomeHigh-level attention to detailIntermediate level computer skills; MS Outlook, Excel, Word, Adobe, PowerPoint as well as general knowledge of data base programs and spreadsheet options; TeamMate Plus software experience desiredThis is a remote position.
Compensation: $70,000.00 - $90,000.00 per year
About StrategyGen
Empowering Decisions with Precision and Insights
StrategyGen
was founded in 2009 and received its SBA
HUBZone
small business certification in 2021. We are a unique and differentiated
HUBZone
small business that provides highly specialized policy and regulatory specialists, market researchers, healthcare professionals, physicians, clinicians, and SME PhD's.
StrategyGen's Mission
Our Mission is to exceed our clients' expectations by providing innovative, pragmatic and cost-effective solutions for their most complex problems.
Vision
Our Vision is to improve the health of healthcare for good.
Values
Act with the highest integrity and ethics.Focus on collaboration.Create long-term partnerships and relationships.Approach change as an exciting opportunity.Provide the customer with deliverables of the highest quality.Be proactive and exceed expectations.Respect and value others.Accept responsibility.Lead with care, compassion, and empathy.
Job Summary
The Health Insurance Examiner is responsible for performing multiple tasks and market conduct activities to evaluate health insurance issuers (Issuers) compliance with state and federal laws and regulations, such as the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA). Market conduct activities may include onsite or desk audits, compliance and form filing reviews, market conduct examinations, and regulatory investigations.
Candidates for this position must have extensive knowledge and experience in the health insurance sector, hold the Market Conduct Management (MCM) designation, and possess strong communication and interpersonal skills with the ability to work independently and collaboratively with cross-functional teams, key stakeholders, senior leaders and clients. Additionally, candidates should have excellent analytical, organizational and project management skills with the ability to prioritize multiple tasks and adapt to changing priorities to ensure delivery of high-quality, on time and within budget work products and deliverables.
Responsibilities/Duties:
Collaborate with the senior examiners, Examiner-in-Charge (EIC) and review team to develop, prioritize and execute assigned market conduct activities, provide regular updates and escalate risks and issues to the EIC and Project OfficerAssist in preparing requests for information to Issuers, and/or with preparing work plans for each market conduct examination, as applicableCollect and objectively analyze Issuers records, files, and data to evaluate compliance with state and federal laws, regulations and requirementsDocument findings, prepare and submit workpapers and other deliverables for supervisory review that include the procedures performed, conclusions reached and supporting documentation for findings that are not in compliance or where errors are identifiedAssist with preparing draft reports, exhibits and supporting documentation that contain detailed examination findings and recommendations for appropriate actionsPerform research and analysis of regulatory updates and guidance issued by CCIIO to Issuers to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulationsReview and support the update of examination protocols when new regulations are released to ensure that they reflect the latest informationServe as a subject matter expert (SME) and as a resource and mentor to other staffPerform other duties as assignedEducation and Experience:
Bachelor's degree from an accredited college plus 1 - 2 years of relevant experienceSignificant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigationMust hold the Market Conduct Management (MCM) designation from the Insurance Regulatory Examiners SocietyAccredited Insurance Examiner (AIE) designation - a plusSpecific Knowledge and Skills:
Extensive knowledge of state and federal laws and regulations pertaining to the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA), health insurance, and/or healthcare servicesIn-depth knowledge of standards and processes in the NAIC's Market Regulation Handbook; knowledge of health care laws and regulations (HIPAA, ERISA) a plusStrong project management, organizational, communication and writing skills, with the ability to change priorities quickly, handle multiple tasks simultaneously and meet deadlinesExcellent interpersonal skills, with the ability to build strong working relationships, give and follow instructions accurately and efficiently while being proactive in asking clarifying questions to ensure work effort is directed toward desired outcomeHigh-level attention to detailIntermediate level computer skills; MS Outlook, Excel, Word, Adobe, PowerPoint as well as general knowledge of data base programs and spreadsheet options; TeamMate Plus software experience desiredThis is a remote position.
Compensation: $70,000.00 - $90,000.00 per year
About StrategyGen
Empowering Decisions with Precision and Insights
StrategyGen
was founded in 2009 and received its SBA
HUBZone
small business certification in 2021. We are a unique and differentiated
HUBZone
small business that provides highly specialized policy and regulatory specialists, market researchers, healthcare professionals, physicians, clinicians, and SME PhD's.
StrategyGen's Mission
Our Mission is to exceed our clients' expectations by providing innovative, pragmatic and cost-effective solutions for their most complex problems.
Vision
Our Vision is to improve the health of healthcare for good.
Values
Act with the highest integrity and ethics.Focus on collaboration.Create long-term partnerships and relationships.Approach change as an exciting opportunity.Provide the customer with deliverables of the highest quality.Be proactive and exceed expectations.Respect and value others.Accept responsibility.Lead with care, compassion, and empathy.