Policy and Form Reviewer

Contact Us
  • Remote
  • Wednesday, July 1st, 2020

Examination Resources, LLC

Job Description

Policy and Form Reviewer


Examination Resources, LLC (ER) is recruiting to fill a contract position for a Policy and Form Reviewer.  Primary duties of the position include the review and analysis of health insurance product submissions (i.e., policies, riders, amendments, endorsements, evidence of coverage, Summary of Benefits and Coverages, solicitations, compliance review tools, etc.); submitted through System for Electronic Rates & Forms Filing (SERFF) and Health Insurance and Oversight System (HIOS) to ensure 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:

  • Review and analysis of health insurance product submissions.
  • Deliver appropriate objections and recommendations regarding compliance of health insurance contract provisions at very high standards.
  • Population of TeamMate and SERFF systems, collection tools, and other documents needed for documenting and communicating compliance findings.
  • Completion of status and special reports, and projects as needed in a timely manner.
  • Maintain up-to-date understanding of relevant health insurance policy changes.

Required Qualifications:

  • 2 years’ experience drafting or reviewing health insurance policy forms.
  • Ability to adapt to changing priorities, self-motivated and energetic in depth knowledge of health insurance laws and regulations, with particular emphasis in the Affordable Care Act (ACA).
  • Strong analytical abilities and attention to detail.
  • Exceptional written and oral communication skills.
  • Familiarity with Center for Medicaid and Medicare Services’ (CMS) 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).

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: Accredited Insurance Examiner (AIE), Market Conduct Management (MCM), Fellow Life Management Institute (FLMI), and Associate Professional in Insurance Regulation (APIR).

Who Should Apply:

  • 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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