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Craig Moore, CFE, CPBS, CPA


Craig has 30 years of experience in providing audit and insurance consulting services to state and federal regulators. As the Director of MLR and PBM Compliance Services, he leads ER’s efforts in performing PBM examination related services for state regulators, as well as MLR examinations on behalf of CCIIO and state insurance departments. Through these efforts, he has extensive knowledge and experience in the analysis and review of PBM contracts and pharmacy reimbursement data. This experience led him to seek additional training and knowledge in the field of PBMs, which he obtained through attaining the Certified Pharmacy Benefit Specialist (CPBS) designation. He was a critical resource to the CMS during the initial implementation of the ACA, leading the charge in the development of the MLR examination program currently in place, including the development of detailed examination procedures for analyzing spread pricing arrangements between PBMs and insurers. He has been responsible for the supervision of over 120 MLR examinations over the past 10 years and is one of the leading experts in the industry with regards to the MLR calculation and rebate and reporting requirements. He has developed and presented various training topics to state insurance departments and at the annual SOFE and IRES career development seminars, including many topics related to the increasing regulation of PBMs, the MLR calculation, the ACA, as well as the risk-focused examination approach.