Examiner-in-Charge – Policy and Form Review

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  • Remote
  • Wednesday, July 1st, 2020

Examination Resources, LLC

Job Description:  

Examiner-in-Charge – Policy and Form Review

Summary:

Examination Resources, LLC (ER) is recruiting an Examiner-in-Charge to fill a position that will oversee and manage the successful completion and comprehensive analysis of health insurance product filings. Ensure reviews are performed in accordance with the procedures and processes developed by ER, compliance with applicable federal and state laws, regulations, guidance issued by the Departments of Health and Human Services, Labor and the Treasury, and state insurance department bulletins and policies.

Key Requirements:

  • Supervises multiple policy and form reviewers (PFR); provides guidance and assistance as needed.
  • Oversees delegation of review work assigned to staff; maintains project and daily work schedules.
  • Ensures accurate and detailed reviews are performed by PFRs, in accordance with compliance procedures developed by state and federal government, and ER.
  • Completes detailed reviews of PFR’s objections and recommendations, TeamMate and System for Electronic Rates & Forms Filing (SERFF) policy assignments, collection tool outputs and other documents; follows up on any reviewer notes or findings that need to be research or reviewed by staff.
  • Maintains up-to-date understanding of relevant health insurance policy changes.
  • Assists with on-going training and development of staff members, and the annual updating of procedural and guidance documents, related to policy form reviews.
  • Provides input on performance for those staff members supervised.
  • Obtains continuing education, as required, for all credentials and designations.

Required Qualifications:

  • 5 years’ experience drafting or reviewing health insurance policy forms.
  • 3 years’ experience working as a team lead or 2 years’ experience working as a manager.
  • In depth knowledge of health insurance laws and regulations, with particular emphasis in the Affordable Care Act (Summary of Benefits and Coverages, Essential Health Benefits, Prescription Drug Formularies, and Mental Health Parity Addiction Equity Act).
  • Ability to adapt to changing priorities, self-motivated and energetic qualities.
  • Strong analytical abilities and attention to detail.
  • Exceptional written and oral communication skills.
  • Familiarity with Center for Medicaid & Medicare Services’ Marketplace Review tools (i.e., Master Review Tool, Prescription Drug Form Review Suite, and Plan and Benefits).
  • Experience using Microsoft Office Suite (i.e., Word, Excel, Access, PowerPoint, and Outlook) and Adobe Acrobat PDF.

Preferred Qualifications:

  • Working knowledge of Health Insurance and Oversight System (HIOS), SERFF and TeamMate.
  • Experience and ability to work both independently and within a team environment.
  • Preferred designations: Certified Insurance Examiner (CIE), Accredited Insurance Examiner (AIE), Market Conduct Management (MCM), Fellow Life Management Institute (FLMI), Associate Professional in Insurance Regulation (APIR), and Senior Professional in Insurance Regulation (SPIR).

Who Should Apply:

  • Product Managers
  • Senior Form Analysts
  • Compliance Professionals

Resume Submission Information:

Qualified candidates are invited to submit their resumes to theacook@examresources.net.

Please include:

  • Current resume.
  • A detailed letter of interest describing your skills and experience as they relate to the qualifications outlined in this job announcement.

The Right Fit.

Join a dynamic group of insurance regulatory consultants with a mission of protecting consumers as it relates to mental health access and services. This role is remote but everything our team does is connected. This position will require an ability to work both very independently and as a team player; your communication style is curious, candid, and direct; you have a sense of urgency and will act promptly to respond to issues that arise and deadlines that change, and; you enjoy finding opportunities to create efficiencies to ensure the best delivery of services to our customers.

 

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