The Examiner will review health insurance policy forms and other documents with respect to compliance with the Patient Protection and Affordable Care Act (ACA), market reforms and other federal and state statutes. The work will be conducted on behalf of federal and state regulatory authorities. There are multiple openings and opportunities on both a salaried and 1099 contractor basis.

The Examiner will perform the following duties:

· Analyze health insurance product submissions (i.e., policies, riders, amendments, endorsements, evidence of coverage, Summary of Benefits and Coverages, solicitations, compliance review tools, etc.) to ensure compliance with applicable federal and state laws.

· Deliver appropriate objections and recommendations regarding compliance of health insurance contract provisions at very high standards.

· Complete the work with high quality and within defined timelines.

· Actively participate in peer review as part of the quality program.

· Maintain up-to-date understanding of relevant health insurance policy changes.

A preferred candidate will have the following qualifications:

· Exceptional written and oral communication

· Proficient in Microsoft Office (Word, Excel, PowerPoint, Teams, and Outlook) and Adobe Acrobat PDF

· Ability to work independently and with a team in a remote environment

· Ability to adapt to changing priorities, self-motivated and knowledge of health insurance laws and regulations, with particular emphasis in the Affordable Care Act (ACA).

· MCM designation issued by Insurance Regulatory Examiners Society (IRES), or ability to obtain designation within 90 days of initial engagement.

· Two years of work experience in a healthcare-related field, or other directly related experience.

· Knowledge of the Affordable Care Act and the Consolidation Appropriations Act, and their application to health insurance policies

· Knowledge/understanding of the clinical aspects of health care delivery in the U.S., such as billing/coding, pharmacy formularies, claims processing

· 2 years’ experience drafting or reviewing health insurance policy forms

· Ability to interpret regulations and make decisions based on those regulations