Benefits: 401(k) matching Competitive salary Dental insurance Flexible schedule Health insurance Paid time off Training & development Vision insurance StrategyGen is seeking experienced Health Insurance Senior Examiner(s) to join our team! This is a full-time remote position, with limited travel. StrategyGen offers competitive compensation, a generous benefits package, flexible schedules, and a collaborative work environment. The Senior Examiner is responsible for performing multiple tasks and market conduct activities to evaluate health insurance issuers (Issuers) compliance with state and federal laws and regulations, such as the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA). Additionally, the Senior Examiner may be assigned to serve as a team lead or team member supporting a project team. Market conduct activities may include onsite or desk audits, compliance and form filing reviews, market conduct examinations (MCEs), and regulatory investigations. Candidates for this position must hold the Certified Insurance Examiner (CIE) designation, have extensive knowledge and experience in the health insurance industry, including performing and/or leading MCEs and MPHAEA NQTL analysis audits, and possess strong communication and interpersonal skills with the ability to work independently and collaboratively with cross-functional teams, key stakeholders, senior leaders and clients. Additionally, candidates should have excellent analytical, organizational and project management skills with the ability to prioritize multiple tasks and adapt to changing priorities to ensure delivery of high-quality, on time and within budget work products and deliverables. Responsibilities/Duties: Collaborate with the Examiner-in-Charge (EIC), Project Task Lead, and other project team members to develop, prioritize and execute assigned market conduct activities, provide regular updates and escalate risks and issues to the EIC and Project Officer Identify, or assist the EIC or Task Lead with identifying, necessary information and methodology, including required documents and data sample sizes, preparing work plans for MCEs, preparing data requests for entities and evaluating submitted data to ensure accuracy and relevance to reviews, examinations, investigations, and/or audits Collect and objectively analyze Issuer records, files, and data to evaluate compliance with state and federal laws, regulations and requirements Document findings, prepare and submit workpapers and other deliverables for supervisory review that include the procedures performed, conclusions reached and supporting documentation for findings that are not in compliance or where errors are identified Prepare and/or assist with preparing draft reports, exhibits and supporting documentation that contain detailed examination findings and recommendations for appropriate actions As Team Lead for assigned Task-specific projects, lead a group of examiners in conducting plan document reviews, MCEs, investigations and/or audits, including the planning, organizing, scheduling, assigning, and reviewing of work products and deliverables submitted by project team Conduct and/or participate in entrance and exit conferences with examined companies Perform, as assigned, the reporting and signing of MCEs and audits and ensure accurate entry into TeamMate Plus and other applicable databases for tracking and monitoring Manage research and analysis of regulatory updates and guidance issued by CCIIO to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulations Review and support the update of examination protocols when new regulations are released to ensure that they reflect the latest information Serve as a Subject Matter Expert, and as a resource and mentor for other staff Perform other duties as assigned Education and Experience: Bachelor's degree from an accredited college/university, plus 5 years of professional experience Significant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigation At least three (3) years of progressive professional work experience as an insurance auditor, including conducting MCEs and MPHAEA NQTL analysis audits and in a leadership or management role overseeing and conducting examinations, investigations and/or audits Must hold the Certified Insurance Examiner (CIE) designation from the Insurance Regulatory Examiners Society, as well as the Market Conduct Management (MCM) designation Specific Knowledge and Skills: Extensive knowledge of state and federal laws and regulations pertaining to the Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MPHAEA) and No Surprises Act (NSA), health insurance, and/or healthcare services In-depth knowledge of standards and processes in the NAIC's Market Regulation Handbook, knowledge of health care laws and regulations (HIPAA, ERISA) a plus Strong project management, organizational, communication and writing skills, with the ability to change priorities quickly, handle multiple tasks simultaneously and meet deadlines Excellent interpersonal skills, with the ability to build strong working relationships, give and follow instructions accurately and efficiently while being proactive in asking clarifying questions to ensure work effort is directed toward desired outcome High-level attention to detail Proficiency with MS Outlook, Excel, Word, Adobe, PowerPoint, general knowledge of data base programs and spreadsheet options, TeamMate Plus software experience desired This is a remote position. Compensation: $90,000.00 - $115,000.00 per year About StrategyGen Empowering Decisions with Precision and Insights StrategyGen was founded in 2009 and received its SBA HUBZone small business certification in 2021. We are a unique and differentiated HUBZone small business that provides highly specialized policy and regulatory specialists, market researchers, healthcare professionals, physicians, clinicians, and SME PhD's. StrategyGen's Mission Our Mission is to exceed our clients' expectations by providing innovative, pragmatic and cost-effective solutions for their most complex problems. Vision Our Vision is to improve the health of healthcare for good. Values Act with the highest integrity and ethics. Focus on collaboration. Create long-term partnerships and relationships. Approach change as an exciting opportunity. Provide the customer with deliverables of the highest quality. Be proactive and exceed expectations. Respect and value others. Accept responsibility. Lead with care, compassion, and empathy. StrategyGen Co
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