Exam Manager – MLR exams

Examination Resources, LLC; Northern (KY); Hybrid; USD 100,000 - 130,000; Full time

Job summary

Examination Resources, LLC seeks an Exam Manager / Examiner-in-Charge to oversee comprehensive MLR examinations for federal and state clients, ensuring compliance with procedures established by CCIIO/HHS. The role is remote, with no travel.

You will lead exam teams, review work papers, analyze premium and claims data using ACL or similar tools, and guide staff toward high-quality findings. A background in healthcare auditing and leadership is highly valued.

Qualifications

• Prior audit/examination management experience is required.
• Experience with MLR or healthcare auditing or accounting is required.
• Bachelor's Degree in Accounting or Finance is preferred, but not required.
• Ability to obtain CPA, CIA, CFE, and/or AFE designations.
• 3+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, or related entity.
• Experience leading others.
• Knowledge of the NAIC Accounting and Practices and Procedures Manual.
• Excellent written and verbal communication skills.
• Strong interpersonal, presentation, analytical and examination/audit skills.
• Excellent organizational skills and ability to prioritize multiple tasks.

Responsibilities

• Oversee work streams and staff examiners; maintain exam/project schedule.
• Manage interactions with examinee company contacts.
• Supervise multiple examiners; provide guidance as needed.
• Complete MLR examination procedures.
• Review work papers for accuracy and organization.
• Provide input on performance for supervised examiners.
• Analyze premium and claims data with ACL to select samples and create reports.
• Obtain continuing education for credentials.

Skills

Audit management

MLR/auditing

Communication skills

Leadership

Time management

Microsoft Office

Data analysis

Self-motivation

Independent work

Education

Bachelor's in Accounting/Finance

CPA/CIA/CFE/AFE designations

Tools

ACL

Tableau

Power BI

Excel

Job description

The Exam Manager / Examiner-in-Charge (EIC) will ensure the successful completion of comprehensive Medical Loss Ratio (MLR) Examinations in accordance with the procedures and processes developed by the Center for Consumer Information and Insurance Oversight (CCIIO) , a division of the Department of Health and Health Services (HHS) responsible for implementation of the Affordable Care Act (ACA). Examinations may also be performed on behalf of various state insurance departments.

Experience with MLR or healthcare insurance auditing or accounting required. Experience with MLR and rebate requirements, or accounting/auditing in the healthcare, insurance , banking and/or Pharmacy Benefit Management (PBM) industries a plus, highly desired. All work is expected to be completed remotely; no travel required.

Specific Duties and Responsibilities

• Oversee work streams and staff examiners; maintain exam/project schedule.
• Manage interactions and communications with examinee company point(s) of contact.
• Supervise multiple examiners; provide guidance and assistance to examiners as needed.
• Complete MLR examination procedures to supplement work of other staff, as necessary.
• Perform detailed reviews of examination work papers completed by other staff, ensuring accurate and organized work papers are prepared in accordance with the expectations of federal and state government clients, as applicable.
• Provide input on performance for those examiners supervised.
• Manage the analysis of premium and claims data through the use of ACL in order to select samples, extract information and create reports, as applicable.
• Obtain continuing education, as required, for all credentials and required designations.
• Ability to adapt to a fast-paced environment.

Required Qualifications

• Prior audit/examination management experience required.
• Experience with MLR or healthcare auditing or accounting required.
• Bachelor's Degree in Accounting or Finance is preferred, but not required.
• Ability to obtain CPA, Certified Internal Auditor (CIA), Certified Financial Examiner (CFE), and/or Accredited Financial Examiner (AFE) designations.
• 3+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or other entity involved in conducted MLR related audits.
• Experience leading others.
• In-depth knowledge of the NAIC's Accounting and Practices and Procedures Manual.
• Exceptional written and verbal communication skills.
• Strong interpersonal, presentation, analytical and examination/audit skills
• Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills
• Must be self-motivated, work well independently and possess a sense of urgency
• Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Adobe Acrobat PDF.
• Experience interpreting output from Audit Command Language (ACL), Tableau, or other similar data mining tools a plus.

The pay range for this role is:

100,000 - 130,000 USD per year (Remote (United States))