Examiner-in-Charge – Medical Loss Ratio (MLR) Examinations

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Job Description:

Examiner-in-Charge – Medical Loss Ratio (MLR) Examinations

Summary

The MLR Examiner-in-Charge (EIC) will ensure the successful completion of comprehensive MLR Examinations in accordance with the procedures and processes developed by the Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Department of Health and Human Services (HHS) responsible for implementation of the Affordable Care Act (ACA). Examinations may also be performed on behalf of various state insurance departments.  Experience with healthcare and/or insurance accounting/auditing highly desired. Experience with MLR and rebate requirements, or other components of the ACA, a plus, but not required. All work is anticipated to be completed remotely; no travel required.

Key Requirements

  • Oversee work streams and staff examiners; maintain exam/project schedule.
  • Manage interactions and communications with examinee company point(s) of contact.
  • Supervise multiple examiners; provide guidance and assistance as needed.
  • Complete MLR examination procedures to supplement work of other staff, as necessary.
  • Perform detailed reviews of examination work papers completed by other staff, ensuring accurate and organized work papers are prepared in accordance with the expectations of federal and state government clients, as applicable.
  • Provide input on performance for those examiners supervised.
  • Manage the analysis of premium and claims data through the use of ACL in order to select samples, extract information and create reports, as applicable.
  • Obtain continuing education, as required, for all credentials and designations.
  • Ability to adapt to a fast-paced environment.

Required Qualifications:

  • CFE or CPA designation; Prior audit/examination management experience preferred.
  • 3+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or state/Federal agency
  • Experience leading others.
  • In-depth knowledge of the NAIC’s Accounting and Practices and Procedures Manual.
  • Exceptional written and verbal communication skills.
  • 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
  • Must be self-motivated, work well independently and possess a sense of urgency
  • Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.

Preferred Qualifications:

  • Prior EIC experience
  • Medicare-related auditing and/or general Medicare experience desirable

Resume Submission Information:

Qualified candidates are invited to submit their resumes and detailed letter of interest to erikasamuelian@examresources.net.

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.