Exam Manager – MLR Exams

This is a fully remote position, open to applicants in United States.

📋 Description

• Ensure the successful execution of extensive Medical Loss Ratio (MLR) examinations in alignment with CCIIO procedures and protocols.

• Supervise work streams and staff examiners while maintaining the examination/project timeline.

• Manage interactions and communications with contacts from the examinee company.

• Oversee multiple examiners, providing guidance and support as necessary.

• Complete MLR examination procedures to assist with the work of other staff as required.

• Conduct thorough reviews of examination work papers to ensure accuracy, organization, and compliance with the expectations of federal and state government clients.

• Offer performance feedback for supervised examiners.

• Manage the analysis of premium and claims data utilizing ACL to select samples, extract information, and generate reports.

• Obtain necessary continuing education to maintain credentials and designations.

• Adapt to a dynamic and fast-paced work environment.

⛳️ Requirements

• Experience in MLR or auditing/accounting within the healthcare insurance sector is required.

• Prior experience in audit/examination management is necessary.

• A Bachelor's Degree in Accounting or Finance is preferred, though not mandatory.

• Ability to obtain CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) designations.

• Over 3 years of experience as an accountant, auditor, examiner, or analyst with a state insurance department, a public accounting firm, an insurance company, or another entity conducting MLR-related audits.

• Proven experience in leading others.

• Comprehensive understanding of the NAIC's Accounting Practices and Procedures Manual.

• Excellent written and verbal communication skills.

• Strong interpersonal, presentation, analytical, and examination/audit abilities.

• Outstanding organizational skills, with the capacity to prioritize multiple tasks, projects, and assignments through effective time management.

• Must be self-driven, able to work independently, and exhibit a sense of urgency.

• Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.

• Experience in interpreting outputs from Audit Command Language (ACL), Tableau, or similar data mining tools is highly desired.

🏝️ Benefits

• Fully remote work.

• No travel required.

• Continuing education, as necessary, for all credentials and required designations.