Senior Compliance Examiner/Auditor – MLR exams

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

📋 Description

• Conduct analytical reviews of documentation that supports MLR calculations and rebate distributions to ensure compliance with both state and federal regulations.

• Execute attribute and accuracy assessments of premium, claims, and other transactions related to MLR calculations.

• Evaluate Quality Improvement Activity expenses and intercompany allocations.

• Analyze Pharmacy Benefit Manager contracts and prescription drug claims data for adherence to relevant laws and regulations.

• Interpret MLR regulations, filing guidelines, and technical instructions in relation to company documentation.

• Draft or oversee the creation of clear and concise examination conclusions in written form.

• Support or lead the development of internal MLR training and audit procedures.

⛳️ Requirements

• Required experience in MLR or healthcare insurance auditing or accounting.

• At least 2 years of experience as an accountant, auditor, examiner, or analyst within a state insurance department, public accounting firm, insurance company, or another entity involved in MLR audits.

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

• CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) credentials are preferred, but not required.

• Proficient PC skills, including experience with presentation, spreadsheet, and project-planning software.

• Familiarity with TeamMate, ACL/Access/Tableau, as well as MS Excel, Word, and PowerPoint.

• Possess strong interpersonal, presentation, analytical, and examination/audit abilities.

• Excellent organizational capabilities and the ability to prioritize multiple tasks through effective time management.

• Strong written and verbal communication skills.

• A dynamic and adaptable personality, coupled with outstanding customer service skills.

• Self-driven, capable of working independently, and able to exhibit a sense of urgency.

• Must demonstrate the ethical and professional standards set forth by the firm.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• 401(k) plan with company match.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuing education.

• Flexible work arrangements and a supportive work environment.