Remote Senior MLR Compliance Auditor

Examination Resources, LLC; Northern (KY); Hybrid; USD 75,000 - 110,000; Full time

Job summary

Examination Resources, LLC is seeking a Senior Compliance Examiner/Auditor to support comprehensive Medical Loss Ratio (MLR) examinations. The role involves analyzing MLR calculations, rebate distributions, and QA testing of premium and claims data, with emphasis on regulatory compliance under CCIIO/HHS ACA frameworks.

Experience in auditing or accounting within healthcare insurance is highly valued. The position is remote, with no travel, and requires strong analytical, interpersonal, and

Qualifications

• Experience with MLR or healthcare insurance auditing or accounting is required.
• Bachelor's Degree in Accounting or Finance is preferred, but not required.
• Minimum 2+ years’ experience as an accountant, auditor, examiner or analyst with a state insurance department, public accounting firm, insurance company, or other entity involved in MLR audits.
• CPA, CIA, CFE, and/or AFE certifications are preferred but not required.
• Proficient in presenting, spreadsheets, and project planning software such as TeamMate, ACL/Access/Tableau, MS Excel, Word and PowerPoint.

Responsibilities

• Perform analytical reviews of documentation supporting MLR calculations and rebate distributions for compliance with state/federal laws.
• Test accuracy of premium and claims transactions and other major MLR components.
• Review QIA expenses to ensure costs meet definitions and intercompany allocations are fair.
• Review PBM contracts and prescription data for regulatory compliance.
• Interpret MLR regulations and guidance against provided documentation.
• Draft or supervise clear written conclusions on MLR procedures.
• Assist and contribute to internal MLR trainings and audit procedures.

Skills

Auditing

Accounting

MLR compliance

Healthcare insurance auditing

Analytical skills

Interpersonal skills

Time management

Communication skills

Examination/audit

Education

Bachelor's Degree in Accounting or Finance

CPA

CIA

CFE

AFE

Tools

TeamMate

ACL/Access

Tableau

MS Excel

MS Word

PowerPoint

Job description

Examination Resources, LLC is seeking a Senior Compliance Examiner/Auditor to support comprehensive Medical Loss Ratio (MLR) examinations. The role involves analyzing MLR calculations, rebate distributions, and QA testing of premium and claims data, with emphasis on regulatory compliance under CCIIO/HHS ACA frameworks.

Experience in auditing or accounting within healthcare insurance is highly valued. The position is remote, with no travel, and requires strong analytical, interpersonal, and