Manager, Market Conduct Exams

Overview

The organization is seeking a Manager, Market Conduct Exams to lead and coordinate market conduct exams (MCEs) across the nation. This role serves as the primary liaison for completing examinations on behalf of the organization’s PBM entity with state regulators, using applicable state rules and regulations, established procedures, and industry standards and best practices.

The manager will coordinate data and document responses with internal departments for audits/examinations, communicate with regulators regarding requests and clarifications, and finalize responses with the approval of the VP, Deputy General Counsel, and Regulatory and Implementation Liaison Sr. Staff Attorney.

Responsibilities

• Create processes and procedures for Market Conduct Exams, including an MCE Handbook for the PBM organization, in compliance with applicable industry standards and state or federal regulatory requirements.
• Serve as the primary contact for internal departments, state regulators, and examiners by:
  • Sending appropriate acknowledgment of the MCE
  • Notifying internal departments of MCE requests
  • Gathering and organizing relevant information from internal departments to respond to MCE requests
  • Ensuring internal data/documents are completed and submitted in a timely manner
• Review response documents and data to ensure accuracy and draft MCE responses for VP, Deputy General Counsel, and Regulatory and Implementation Liaison Sr. Staff Attorney approval.
• Prepare and deliver required MCE responses to state regulators or examiners in the required format/platform for secure and efficient submission.
• Review action plans or orders received on behalf of the PBM organization and collaborate with the Implementation Team to resolve outstanding issues for the enterprise.
• Participate in meetings with internal staff, outside counsel, VP, Deputy General Counsel, Implementation Director, Regulatory and Implementation Liaison Sr. Staff Attorney, and Senior Leadership (on-site or remote) as a subject matter expert on MCE, including advising on updates, market trends, and document/data requirements.
• Lead PBM audit examinations across various states and coordinate with the organization’s related PBM entities in accordance with state requirements.
• Interpret state rules and regulations related to PBM enforcement requirements and corresponding examinations.
• Ensure all deadlines presented by the examination workplan schedule and PBM management are met.
• Supervise multiple examinations and workflow processes required for each MCE/examination.
• Strategize and collaborate with PBM leadership for a favorable MCE result.
• Support MCE responses, legal review, research, and writing.
• Assist leadership in PBM practice development activities, including strategic discussions, tasks, and partnerships.
• Present at Regulatory Council Meetings and provide enterprise updates on current PBM legislation and Market Conduct Exam status.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree, preferably in Legal, Business, or Healthcare, or equivalent work experience, required.
• Certified Insurance Examiner (CIE) or Market Conduct Management (MCM) certification required, or ability to become certified within one year of hire.
• 2 years of PBM experience required.
• 5 years’ experience with MCE audits required.
• 5 years’ experience completing examinations in accordance with NAIC Market Regulation Handbook required.
• 5 years’ experience working with auditors, examiners, or analysts with a state insurance department, insurance company, or state/Federal agency related to the PBM industry required.
• Experience in researching proposed and enacted legislative bills related to the PBM industry required.
• Experience leading others regarding PBM licensing, regulatory, and MCE required.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.
• Participate in, adhere to, and support compliance program objectives.
• Ability to consistently interact cooperatively and respectfully with other employees.

Compensation & Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!