Senior Examiner – Medical Loss Ratio (MLR) Examinations

  Examination Resources, LLC Apply Now

Job Description:

Senior Examiner – Medical Loss Ratio (MLR) Examinations


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

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.