Market Conduct PBM Examiner

Financial Regulation; Montpelier (VT); Presencial; USD 80.000 - 120.000; Jornada completa

Descripción de la vacante

The Vermont Department of Financial Regulation seeks a Market Conduct PBM Examiner to monitor and regulate Pharmacy Benefit Managers operating in the state. This role conducts examinations and investigations to assess compliance, including contract review and claims data analysis, with clear reporting and compliance planning responsibilities.

Ideal candidates bring several years of PBM regulatory experience, strong communication skills, and the ability to navigate complex regulatory situations

Formación

• Four years of experience in insurance regulation, market conduct examination, PBM compliance, or healthcare policy.
• Two years at supervisory or lead examiner level.
• Experience reviewing PBM contracts and analyzing pharmacy claims data.
• Strong communication and regulatory interpretation skills.
• Professional insurance regulation certifications preferred (APIR, PIR, MCM, AIE, CIE).

Responsabilidades

• Monitor and regulate PBMs operating in Vermont.
• Conduct examinations and investigations to assess compliance with Vermont laws.
• Perform contract reviews and analyze pharmacy claims data.
• Prepare reports and help develop compliance plans for PBMs.

Conocimientos

PBM experience

Regulatory analysis

Contract review

Claims data analysis

Strong communication

Educación

Bachelor's degree in a relevant field

Descripción del empleo

The Vermont Department of Financial Regulation seeks a Market Conduct PBM Examiner to monitor and regulate Pharmacy Benefit Managers operating in the state. This role conducts examinations and investigations of PBMs and third-party administrators to assess compliance with Vermont laws, involving contract review, claims data analysis, report writing, and compliance planning. The position requires experience with PBM operations or pharmacy claims, strong communication skills, and the ability to navigate complex regulatory situations.

Key qualifications

• Four years of experience in insurance regulation, market conduct examination, PBM compliance, or healthcare policy; or two years as a Market Conduct Examiner with health insurance/PBM focus
• Two years at supervisory or lead examiner level
• Experience reviewing PBM contracts and analyzing pharmacy claims data
• Strong communication and regulatory interpretation skills
• Professional insurance regulation certifications preferred (APIR, PIR, MCM, AIE, CIE)