Senior Advisor, Market Conduct (PBM/Health Plan)
About The Position
Assists with and, as appropriate, takes the lead to facilitate examination activity for MCE issues involving Express Scripts and its affiliated entities as well as EviCore. Partners with other market conduct team members and, as appropriate, takes the lead on examinations to manage requests for information, facilitate responses to requests with business partners, and establish and maintain contacts with key business partners and Department of Insurance and other regulatory examiners. Work in partnership with other market conduct team members to address and/or receive guidance on addressing findings and corrective action plans with business partners and to facilitate resolution of the exam and any proposed fines or penalties.
Requirements
- Bachelor’s degree or equivalent experience
- Minimum 5+ years of regulatory, compliance, or market conduct experience within health insurance, PBM, or utilization management (UM)
- Experience supporting or managing market conduct examinations (MCEs) or working directly with Department of Insurance (DOI) regulators and exam processes
- Demonstrated ability to manage regulatory examinations, including coordinating responses, analyzing findings, and supporting corrective action plans
- Strong knowledge of PBM and/or UM operations, regulatory frameworks, and business processes
- Proven ability to manage complex, regulator-facing matters and drive outcomes
- Excellent written and verbal communication skills, with the ability to present company positions to regulators and internal stakeholders
- Strong organizational skills with the ability to manage multiple deadlines, requests, and stakeholders simultaneously in a matrixed environment
Responsibilities
- Act as Company coordinator for market conduct examinations.
- Serve as liaison to insurance department examiners during the examination process.
- Assess market conduct issues and findings, communicate company position statements, develop appropriate responses and corrective actions, and work with Managing Counsel to negotiate outcomes to mitigate risk for the Cigna companies.
- Collaborate with business partners, including Legal, Regulatory, Account Management, PBM Operations, EviCore and others to ensure MCEs are conducted efficiently.
- Complete all pre-examination surveys, data requirements and examination materials in an accurate and timely manner.
- Provide responses to examiner requests and criticisms within stated/negotiated timeframes.
- Utilize Open Pages, iManage and/or other tools, as appropriate.
- Act as an advisor/consultant to business partners regarding regulatory examinations.
- Communicate market conduct issues and findings, company position statements, and best practices to Legal and business partners.
- Assist in the development of practices to address issues and to close compliance gaps and mitigate risk.
- Develop business partner relationships to assist in fostering a compliant and efficient environment with mutual ownership.
- Assist business partners by providing direction and instruction in responding to MCE requests.
Benefits
- medical
- vision
- dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- 18 days of paid time off per year
- paid holidays
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What This Job Offers
Job Type
Full-time
Career Level
Senior
