Remote Market Conduct PBM Examiner

State of Vermont; Montpelier (VT); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental plan

Paid holidays

Pension plan

Tuition reimbursement

Flexible spending accounts

Job summary

The Vermont Department of Financial Regulation seeks a Market Conduct PBM Examiner to oversee the regulatory oversight of PBMs operating in Vermont. The role includes conducting examinations, reviewing contracts, and analyzing claims data to ensure compliance with state laws and regulations.

Ideal candidates will have PBM experience, strong communication skills, and the ability to interpret laws, with readiness for potentially adversarial discussions and complex negotiations.

Qualifications

• Four (4) years of experience in insurance regulation, market conduct examination, Pharmacy Benefit Management compliance, healthcare policy analysis, or a related field, including two (2) years at a supervisory or lead examiner level.
• OR two (2) years or more as a Market Conduct Examiner with a focus on health insurance or PBM-related matters.

Responsibilities

• Examine and investigate PBMs and third-party administrators to assess compliance with Vermont laws and regulations.
• Review PBM contracts with health plans and pharmacies and analyze pharmacy claims data.
• Write comprehensive reports on findings and work with entities on compliance plans.

Skills

PBM regulations

Communication

Legal interpretation

Negotiation

Regulatory analysis

Job description

The Vermont Department of Financial Regulation seeks a Market Conduct PBM Examiner to oversee the regulatory oversight of PBMs operating in Vermont. The role includes conducting examinations, reviewing contracts, and analyzing claims data to ensure compliance with state laws and regulations.

Ideal candidates will have PBM experience, strong communication skills, and the ability to interpret laws, with readiness for potentially adversarial discussions and complex negotiations.