Market Conduct Examiner I - Health, Life & Pharmaceutical

State of Utah Office of the Governor • Taylorsville, UT

1d • $26 - $30 • Hybrid

About The Position

The Market Conduct Examiner will primarily be tasked with conducting health insurance and pharmaceutical investigations. This is a great opportunity for individuals who are detailed oriented, have investigative skills, and have a comprehensive knowledge of health insurance or pharmaceuticals, including pharmaceutical delivery. Most of the audit and investigation work is done independently with ample opportunities for collaboration with a larger team to discuss issues or policy questions as they arise. Organization skills as well as the ability to clearly communicate, verbally and in writing, compliance issues are integral to this position.

Requirements

• Five or more years of experience in the health insurance and/or pharmaceutical industries, or regulatory field, including experience in:
• Conducting audits
• Investigations, or conflict resolution
• Conflict resolution
• Knowledge of state and federal health insurance laws.
• Strong, well-rounded writing and presentation skills.
• The ability to work both independently and within a team environment.
• The ability to read, understand, apply, and explain federal and state laws.
• Critical thinking skills, adaptable to change, and can effectively analyze complex cases.
• Excellent time management skills and the ability to multitask and prioritize work.
• Market Conduct Examiners may be required to travel throughout the state to conduct investigations.
• You must have a valid driver's license to be considered for this position as per Utah Administrative Code R27-7.
• If you are currently licensed with the Utah Insurance Department, your license will be suspended while you are employed by the Department. Your license can be reactivated once you are no longer employed by the Department.
• A successful background check for new employees is required prior to finalizing an employment offer

Nice To Haves

• Individuals with extensive experience working in a regulatory field, for a health insurance company or working in the pharmaceutical industry are preferred.

Responsibilities

• Investigate and respond to discoveries of non-compliance relating to health insurance and pharmacy benefit managers.
• Conduct, or participate in, market conduct examinations relating to health insurance and pharmacy benefit managers.
• Negotiate outcomes between consumers, insurers, licensees, and the department. Research issues and compile cases.
• Write thorough investigative reports.
• Assist the department's attorneys in developing your cases for hearing. Testify in court as needed.
• Communicate information and ideas clearly and concisely in writing, in person, and by phone. Read and understand information and data presented in order to draw fact-based conclusions.
• Research, interpret, and apply federal and state health insurance laws, regulations, policies, and procedures.

Benefits

• Job Stability: Enjoy the security and reliability of employment within a well-established organization.
• Career Growth: Develop valuable skills and gain opportunities for leadership within a large organization.
• Meaningful Work: Contribute to an important service that benefits the community and supports organizational goals.
• Supportive Work Environment: Be part of a team that values cooperation, strong work ethics, and mutual support.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed