Senior Compliance Examiner/Auditor – MLR exams

Specific Duties and Responsibilities · Perform analytical reviews of documentation provided by companies supporting MLR calculations and distribution of rebates to enrollees for compliance with state and/or federal legislation. · Perform attribute and accuracy testing of premium and claims transactions , and other major components of the MLR calculation to determine completeness and accuracy. · Review Quality Improvement Activity (QIA) expenses , which are costs for activities that improve the quality of care provided to members, ensuring reported costs meet the definition of QIA and that intercompany allocations are fair and reasonable.

· Review Pharmacy Benefit Manager contracts and detailed prescription drug claims data for compliance with applicable state laws and regulations. · Interpret MLR regulations, filing instructions and technical guidance in comparison to documentation provided by companies. · Write and/or supervise others in the written documentation of clear, concise, and informative conclusions on required MLR examination procedures.

· Assist and lead in the creation of internal MLR trainings and audit procedure creation. Requirements · Experience with MLR or healthcare insurance auditing or accounting required. · Bachelor's Degree in Accounting or Finance is preferred, but not required. · Minimum 2+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or other entity involved in conducted MLR related audits.

· CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) preferred, but not required. · PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access/Tableau, and MS Excel, Word and PowerPoint). · 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. · Strong written and verbal communication skills. · Dynamic/flexible demeanor with exceptional customer service skills. · Must be self-motivated, work well independently and possess a sense of urgency. · Ability to demonstrate ethical and professional standards as outlined by the Firm.

Resume Submission Information Qualified candidates are invited to submit their resumes and detailed letter of interest to [email protected]. 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