Market Conduct Examiner (health And Pbm)

RSM UK

Remote
Base: $69,800 - $132,000; bonus/equity: discretion...
Fully remote
Market conduct examinations
Insurance statutes and regulations
Pharmacy benefit management practices
RSM UK is seeking a Market Conduct Examiner to conduct reviews of insurance companies to ensure compliance with state regulations, particularly in health and pharmacy benefit management. The role is remote, and candidates should have significant insurance experience, analytical skills, and knowledge of relevant laws and regulations

Job Summary

  • Perform comprehensive, targeted and risk focused market conduct examinations to determine compliance with states’ insurance statutes and regulations on behalf of state insurance departments.
  • Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to determine compliance with states’ insurance statutes and regulations and interpret their meaning and determine impact to the insurance company.
  • This includes, but is not limited to, analyzing compliance pertaining to review of pharmacy audits conducted by PBMs, spread pricing, pharmacy reimbursement, dispensing fee requirements, annual reports, contract review, financial review, internal and external appeals, claims processing, and network adequacy.

Matching Summary

Match Score: 85

RSM UK is seeking a Market Conduct Examiner to conduct reviews of insurance companies to ensure compliance with state regulations, particularly in health and pharmacy benefit management. The role is remote, and candidates should have significant insurance experience, analytical skills, and knowledge of relevant laws and regulations.

Salary

Base: $69,800 - $132,000; Bonus/Equity: discretionary bonus based on firm and individual performance; Benefits: Not specified

Skills & Requirements

Must-have

  • Market conduct examinations
  • Insurance statutes and regulations
  • Pharmacy benefit management practices
  • Review insurance company documentation
  • Draft examination work papers
  • Analyze reports and records

Nice-to-have

  • Adapt to fast-paced environment
  • Client service skills
  • Collaborative focus
  • Sense of urgency
  • Team building and development

Key Requirements

  • Bachelor’s Degree in Business, Risk Management, Accounting or Finance
  • 5+ years insurance experience
  • Professional insurance designations preferred
  • Skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point
  • Project management experience
  • Ability to interact with all levels

Work Rights

Not specified

Tailored Resume

Cover Letter