Lead Insurance Examiner – ACA Forms & Plan Management

Virginia State Corporation Commission; Richmond (VA); Hybrid; USD 88,000 - 96,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

Virginia State Corporation Commission, Bureau of Insurance in the Life & Health Insurance Division, seeks two Lead Insurance Examiners to oversee ACA forms, plan management, and large group health filings. Responsibilities include leading staff, auditing reviews, and advising on compliance.

Hybrid schedule offered with opportunities for professional development. Qualified candidates have 6+ years in health insurance filings, strong ACA knowledge, and proven leadership abilities.

Qualifications

• Six (6) or more years of professional experience with health insurance product filings.
• Strong knowledge of ACA and group health insurance products.
• Ability to lead, coach, and evaluate staff.

Responsibilities

• Lead, coach, mentor, develop, and evaluate assigned staff.
• Audit rate and form filing reviews and address training needs.
• Provide verbal and written advice on compliance issues for filings.
• Lead projects and prepare complex reports.
• Communicate with regulators, industry personnel, and the public.
• Meet with companies to obtain information, corrections, and amendments.

Skills

Staff leadership

Audit reviews

Policy development

Communication

SERFF

Tools

SERFF

Job description

Lead Insurance Examiner – ACA Forms & Plan Management

Starting Salary Range: $88,275 - $95,500

The State Corporation Commission’s(“SCC”) Bureau of Insurance(“BOI”) seeks two experienced insurance professionals to fill two lead positions in the ACA Forms and Plan Management section in the Life & Health Insurance Division. One Lead Insurance Examiner position will oversee the work of three (3) insurance professionals responsible for ACA and large group health insurance filings, as well as other group accident and sickness filing reviews. The other Lead Insurance Examiner position will oversee the work of two (2) insurance professionals responsible for the review and analysis of applications for carriers to participate on Virginia’s health insurance marketplace as well as ACA and non-ACA group health insurance policy forms. The ACA Forms and Plan Management section is responsible for ensuring that all filings and reviews are compliant with Virginia insurance laws and regulations. The Lead Insurance Examiner positions offer a hybrid work schedule (typically 2 days in office and 3 telework days each week) as well as a variety of professional development and training opportunities.

Essential functions and responsibilities include:

• Lead, coach, mentor, develop, and evaluate assigned staff.
• Assist section manager in training staff and coordinating and monitoring staff workload.
• Audit rate and form filing reviews handled by staff and address any training needs identified through these audits.
• Serve as a subject matter expert and resolve complex analytical or technical issues.
• Participate in the development of policies, procedures, and guidelines.
• Provide verbal and written advice and comment on compliance issues for filings.
• Communicate verbally and in writing with regulators, industry personnel, and the public in response to requests for information, interpretation of contract provisions and laws, or review of staff decisions.
• Correspond and meet with companies to obtain information, corrections, and amendments.
• Provide technical, policy implication, and fiscal impact comments on specific issues related to proposed and enacted legislation impacting the review of ACA products, large group health filings and other group accident and sickness product filings.
• Serve as a liaison with other sections and agencies.
• Lead projects and prepare complex reports.
• Lead and participate in meetings.
• Perform related work as required.

Preferred Qualifications

• Six (6) or more years of professional experience with health insurance product filings, including compliance with ACA requirements.
• Considerable knowledge of ACA and group accident and sickness insurance products.
• Considerable knowledge of insurance terminology, laws, and regulations.
• Ability to effectively lead, manage, coach, develop, train, and evaluate staff.
• Ability to read, review, and analyze insurance policies, related forms, and information related to form and rate filings.
• Ability to understand and interpret sections of the Virginia Insurance and Administrative Codes and correctly determine their applicability to submitted form and rate filings.
• Ability to effectively analyze issues or situations, consider viable options, and make sound recommendations.
• Exceptional verbal and written communication skills.
• Strong attention to detail and critical thinking skills.
• Proficiency in general office software applications and programs such as SERFF.
• Ability to proactively recommend changes and to lead process improvement efforts.
• Ability to meet tight deadlines.
• Ability to establish and maintain effective working relationships with Commission staff, industry personnel and other state and federal agencies.