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. The position conducts examinations and investigations of PBMs and third-party administrators (TPAs) to assess compliance with Vermont laws and regulations, and takes a leading role in Vermont’s newly regulated PBM market. The work includes reviewing PBM contracts with health plans and pharmacies, analyzing pharmacy claims data, preparing comprehensive reports on findings, and working with entities on compliance plans. The role engages with PBM representatives, insurers, legal professionals, and policymakers, potentially involving complex negotiations and high-pressure discussions.
Requirements
- Four years of experience in insurance regulation, market conduct examination, Pharmacy Benefit Management compliance, healthcare policy analysis, or a related field, including two years at a supervisory or lead examiner level; OR two or more years as a Market Conduct Examiner focused on health insurance or PBM-related matters.
- Strong communication skills.
- Experience interpreting laws and regulations.
- Comfort working in potentially adversarial situations.
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.
- Experience with PBM operations and/or pharmacy claims.
Responsibilities
- Monitor and regulate Pharmacy Benefit Managers operating in Vermont.
- Conduct examinations and investigations of PBMs and third-party administrators to assess compliance with Vermont laws and regulations.
- Review PBM contracts with health plans and pharmacies.
- Analyze pharmacy claims data.
- Write comprehensive reports on examination and investigation findings.
- Work with entities on compliance plans.
Benefits
- 80% State-paid medical premium and a dental plan at no cost for employees and their families.
- 11 paid holidays each year and a generous leave plan.
- State-paid Family and Medical Leave Insurance (FMLI).
- State defined benefit pension plan and deferred compensation 457(b) plan.
- Tuition reimbursement.
- Flexible spending healthcare and childcare reimbursement accounts.
- Low-cost group life insurance.
- Incentive-based wellness program.
- Qualified Employer for the Public Service Student Loan Forgiveness Program.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
