Examiner-in-Charge – Medical Loss Ratio (MLR) Examinations

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  • Remote
  • Tuesday, November 16th, 2021

Examination Resources, LLC

Job Description:

Examiner-in-Charge – Medical Loss Ratio (MLR) Examinations


Position Overview:

The MLR Examiner-in-Charge (EIC) will ensure the successful completion of comprehensive MLR Examinations in accordance with the procedures and processes developed by the Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Department of Health and Human Services (HHS) responsible for implementation of the Affordable Care Act (ACA). Examinations may be performed on behalf of the federal government, as well as for various state insurance departments.  Experience with MLR and rebate requirements, or other components of the ACA, a plus, but not required. All work is anticipated to be completed remotely; no travel required.


Specific Duties and Responsibilities:

  • Oversee work streams and examiners; maintain exam/project schedule.
  • Manage interactions and communications with examinee company point(s) of contact.
  • Supervise multiple examiners; provide guidance and assistance as needed.
  • Complete MLR examination procedures to supplement work of other staff, as necessary.
  • Perform detailed reviews of examination work papers completed by other staff, ensuring accurate and organized work papers are prepared in accordance with the expectations of federal and state government clients, as applicable.
  • Provide input on performance for those examiners supervised.
  • Manage the analysis of premium and claims data through the use of Audit Command Language (ACL) in order to select samples, extract information and create reports, as applicable.
  • Obtain continuing education, as required, for all credentials and designations.
  • Ability to adapt to a fast-paced environment.


Required Qualifications:

  • Certified Financial Examiner (CFE) designation.
  • 3+ years of financial or compliance-related regulatory experience;
  • Healthcare insurance industry experience a must.
  • Experience leading others.
  • Experience with examination software TeamMate.
  • In-depth knowledge of the NAIC’s Accounting and Practices and Procedures Manual.
  • Exceptional written and verbal communication skills.
  • Strong interpersonal, presentation, analytical and examination/audit skills.
  • Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills
  • Must be self-motivated, work well independently, and possess a sense of urgency,
  • Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.
  • Experience interpreting output from ACL, Tableau, or other similar data  mining tools a plus.
  •  Ability to demonstrate ethical and professional standards as outlined by the Firm.


Preferred Qualifications:

  • Prior EIC experience
  • Medicare-related auditing and/or general Medicare experience desirable

Resume Submission Information:

Qualified candidates are invited to submit their resumes and detailed letter of interest 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 calculation of the MLR and payment of rebates to healthcare insurance enrollees. 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.