Market Conduct PBM Examiner
About The Position
The Vermont Department of Financial Regulation is seeking a Market Conduct PBM Examiner to monitor and regulate Pharmacy Benefit Managers (PBMs) operating in Vermont. This position conducts examinations and investigations of PBMs and third-party administrators (TPAs) to assess compliance with Vermont laws and regulations. The work involves reviewing PBM contracts with health plans and pharmacies, analyzing pharmacy claims data, writing comprehensive reports on findings, and working with entities on compliance plans. The ideal candidate will have experience with PBM operations and/or pharmacy claims, strong communication skills, experience interpreting laws and regulations, and be comfortable in potentially adversarial situations. This is an opportunity to take a leading role in Vermont's newly regulated PBM market and join a team dedicated to serving Vermonters.
Requirements
- Four (4) years of experience in insurance regulation, market conduct examination, Pharmacy Benefit Management compliance, healthcare policy analysis, or a related field, including two (2) years at a supervisory or lead examiner level.
- OR Two (2) years or more as a Market Conduct Examiner with a focus on health insurance or PBM-related matters.
Nice To Haves
- Associate Professional in Insurance Regulation (APIR)
- Professional in Insurance Regulation (PIR)
- Market Conduct Manager (MCM)
- Accredited Insurance Examiner (AIE)
- Certified Insurance Examiner (CIE)
- Any designation specific to health insurance or PBMs
Responsibilities
- Conduct examinations and investigations of PBMs and third-party administrators (TPAs) to assess compliance with Vermont laws and regulations.
- Review PBM contracts with health plans and pharmacies.
- Analyze pharmacy claims data.
- Write comprehensive reports on findings.
- Work with entities on compliance plans.
Benefits
- 80% State paid medical premium
- Dental plan at no cost for employees and their families
- 11 paid holidays each year
- Generous leave plan
- State Paid Family and Medical Leave Insurance (FMLI)
- State defined benefit pension plan
- Deferred compensation 457(b) plan
- Tuition Reimbursement
- Flexible spending healthcare reimbursement accounts
- Flexible spending childcare reimbursement accounts
- Low cost group life insurance
- Incentive-based Wellness Program
- Qualified Employer for Public Service Student Loan Forgiveness Program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
