Navitus Health Solutions

Manager, Market Conduct Exams

Navitus Health Solutions

full-time

Posted on:

Location Type: Remote

Location: Idaho • United States

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Salary

💰 $98,384 - $122,980 per year

About the role

  • Create processes and procedures for Market Conduct Exams including a MCE Handbook for Navitus in compliance with applicable industry standards, state or federal regulatory requirements.
  • Act as the primary contact person for internal departments, state regulators and examiners, which includes sending the appropriate acknowledgement of the MCE, notifying the appropriate internal departments of the MCE requests, gathering and organize all pertinent and relevant information from internal departments in response to the MCE, and ensuring that all internal data/documents are completed/submitted to respond to the MCE requests in a timely manner.
  • Review response documents and data to ensure accuracy and draft MCE responses to state examiners and regulators for the VP, Deputy General Counsel and Regulatory and Implementation Liaison Sr. Staff Attorney’s approval.
  • Prepare and deliver the required MCE responses to the state regulator or examiner in the format/platform required to submit documents in a secure and efficient manner.
  • Review action plans or orders received on behalf of Navitus and collaborate with the Implementation Team to resolve any outstanding issues for the enterprise.
  • Participate in meetings with internal staff, outside counsel, VP, Deputy Geneal Counsel, Implementation Director, Regulatory and Implementation Liaison Sr. Staff Attorney, and Senior Leadership (on-site or remote) as a subject matter expert on MCE to advise on updates, market trends, document/data requirements/requests/submissions.
  • Lead PBM audit examinations across various states for Navitus and coordinate with Navitus other PBM entities (Archimedes) in accordance with state requirements.
  • Interpret state rules and regulations pertaining to enforcement requirements of PBMs and related examinations thereof.
  • Ensure all deadlines presented by the examination workplan schedule and PBM management are met.
  • Supervise multiple examinations and workflow processes required for each MCE/examination.
  • Strategize and collaborate with Navitus leadership for a favorable MCE result.
  • Assist with MCE responses, legal review, research, and writing.
  • Assist leadership in various PBM practice development activities, including strategic discussions, tasks, and partnerships.
  • Present at the Regulatory Council Meetings and provide updates to the enterprise of current PBM legislation and Market Conduct Exam status.
  • Other duties as assigned.

Requirements

  • Bachelor’s degree, preferably in Legal, Business, or Healthcare, or equivalent work experience, required.
  • Certified Insurance Examiner (CIE) or Market Conduct Management (MCM) certification required, or ability to become certified within one year of hire.
  • 5 years of PBM experience required.
  • 5 years’ experience with MCE audits required.
  • 5 years’ experience completing examinations in accordance with NAIC Market Regulation Handbook required.
  • 5 years’ experience working with auditors, examiners, or analysts with a state insurance department, insurance company, or state/Federal agency related to the PBM industry required.
  • Experience in researching proposed and enacted legislative bills related to the PBM industry required.
  • Experience leading others regarding PBM licensing, regulatory, and MCE required.
  • Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.
  • Participate in, adhere to, and support compliance program objectives.
  • The ability to consistently interact cooperatively and respectfully with other employees.
Benefits
  • Top of the industry benefits for Health, Dental, and Vision insurance
  • 20 days paid time off
  • 4 weeks paid parental leave
  • 9 paid holidays
  • 401K company match of up to 5% - No vesting requirement
  • Adoption Assistance Program
  • Flexible Spending Account
  • Educational Assistance Plan and Professional Membership assistance
  • Referral Bonus Program – up to $750!
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Market Conduct ExamsMCE HandbookPBM audit examinationsexaminations compliancelegal reviewresearchwritingdata accuracydocument submissionstrategic discussions
Soft Skills
collaborationleadershipcommunicationorganizationproblem-solvinginterpersonal skillstime managementsubject matter expertisepresentation skillscooperation
Certifications
Bachelor’s degreeCertified Insurance Examiner (CIE)Market Conduct Management (MCM)