Join our Team

Senior Examiner – Medical Loss Ratio (MLR) Examinations

ER provides equal employment opportunities to all applicants without regard to race, color, creed, ancestry, national origin, citizenship, sex or gender (including pregnancy, childbirth, and pregnancy-related conditions), gender identity or expression (including transgender status), sexual orientation, marital status, religion, age, disability, genetic information, service in the military, or any other protected characteristics.

We are committed to fostering an environment where differences are welcomed and valued. We encourage anyone who feels they may be qualified for a role with us to apply. We look forward to seeing how what you bring can add to our dynamic culture.

Our benefits include:

  • Competitive pay
  • Continuing education reimbursement
  • Medical, dental, vision insurance
  • HSA and FSA options
  • Short-term and long-term disability insurance
  • Life insurance
  • 401k with company match
  • Paid holidays
  • Paid sick leave
  • PTO
  • Vacation reimbursement
  • Paid parental leave
  • Paid bereavement leave
  • Mental health support
  • Monthly gym membership allowance

Job Description

Summary

The MLR Senior Examiner will assist in completing comprehensive MLR Examinations in accordance with the procedures 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 be performed on behalf of the Federal government, as well as for various state insurance departments. Experience with MLR and related 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

  • Perform reviews of documentation provided by companies supporting MLR calculations and distribution of rebates to enrollees.
  • Perform attribute and accuracy testing of premium and claims transactions, and other major components of the MLR calculation.
  • Review Quality Improvement Activity (QIA) expenses, ensuring reported costs meet the definition of QIA and that intercompany allocations are fair and reasonable.
  • Interpret MLR regulations, filing instructions and technical guidance in comparison to documentation provided by companies.
  • Prepare and/or supervise others in the documentation of clear, concise, and informative conclusions on required MLR examination procedures.

Required Qualifications

  • Bachelor’s Degree in Accounting or Finance.
  • Minimum 3+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or state/Federal agency. Healthcare insurance industry experience is a must.
  • In-depth knowledge of the NAIC’s Accounting Practices and Procedures Manual.
  • Certified Financial Examiner (CFE), Accredited Financial Examiner (AFE), and/or CPA preferred, but not required.
  • PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, Audit Command Language (ACL)/Access/Tableau, and MS Excel, Word, PowerPoint, and Adobe Acrobat PDF).
  • 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 are required.
  • 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 to HR@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.

    We'd love to hear from you! Share what services you are interested in and how we can work together to achieve your goals.

    9 + 3 =

    We value your perspective. Share your thoughts, suggestions, or experiences with our team anytime at feedback@examresources.net.

    CORPORATE HEADQUARTERS

    20 10th Street NW, Suite 803
    Atlanta, GA 30309-6197

    Office: 404.816.6188
    Fax: 404.816.6197

    UTAH OFFICE

    10619 S. Jordan Gateway, Suite 335
    South Jordan, UT 84095

    Office: 801.562.5748

    VIRGINIA OFFICE

    145 N. Main Street
    Stuart, VA 24171

    Office: 276.694.3806
    Fax: 404.816.6197