Manager, Market Conduct Exams

Navitus Health Solutions, LLC

34d•$98,384 - $122,980•Remote

About The Position

Due to growth, we are adding a Manager, Market Conduct Exams to our team. The Manager, Market Conduct Exams will act as the liaison for market conduct exams across the nation, using state rules and regulations, established procedures, and industry standards and best practices to complete the examinations on behalf of Navitus to state regulators. The role will take the lead in coordinating data and document responses with internal departments for audits/examinations; communication with regulators regarding requests and clarifications as needed; finalize responses with the approval of the VP, Deputy General Counsel and Regulatory and Implementation Liaison Sr. Staff Attorney. Is this you? Find out more below!

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.

Responsibilities

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 Attorne,y 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.