at RSM US LLP in ChicagoChicago, Illinois, United States
Job Description
We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, inclusive culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM.
Market Regulation PBM Compliance Consultant
Position is work from home
Risk & Regulatory Consulting, LLC
Specific Duties and Responsibilities:
Assess PBM and insurance company's (Entity) compliance with state and federal laws. Understanding of the Entities operations in relation to the insurance transactions and pharmaceutical supply chain is essential.
Evaluate Entities contracts with health plans and pharmacies to determine if they contain discriminatory or non-compliant provisions
Perform comparative reviews of MAC pricing lists/contracts
Conduct reviews of Entities' insurance transactions with consumers to determine compliance with state and federal laws.
Conduct reimbursement methodology reviews, pharmacy audit reviews and network adequacy reviews
Validate and analyze the quarterly and annual data reports
Monitor Entities marketplace activities and trends
Document in writing findings and reports of examinations, as needed
Prepare and present training on such topics
Participate in practice development activities with state and federal state agencies
Requirements:
Must have 3-5 years of insurance company and/or PBM operational and/or compliance/internal audit experience and prior consulting experience in healthcare, managed care, or PBM industries and working knowledge of Pharmacy Benefit Managed Care business or PBM experience
Bachelor's Degree in Business, Risk Management, Accounting, Finance or applicable fields
Ability to interact effectively across department lines and with all levels of management
Must understand the fundamentals of health insurance and the pharmaceutical supply chain, MAC pricing, national average drug acquisition cost (NADAC) reimbursements, spread pricing, and pharmacy claims and balancing clinical, regulatory, pharmaceutical industry issues.
Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook)
Effective written and oral communication skills
Regulatory experience is a plus
Strong analytical abilities and attention to detail
Self-directed and the ability to problem solve in a positive, productive manner
Strong communication skills, collaborative, adaptable to changing priorities and ability to execute on tight deadlines Strong team orientation and the ability to work with a variety of people
Must be comfortable doing presentations and conducting phone calls with multiple team members
Travel as needed
Preferences:
Have or work towards market regulation insurance designations, i.e., Certified Insurance Examiner (CIE), Accredited Insurance Examiner (AIE), Market Conduct Management (MCM)
Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed. RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients.
Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients.
RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES.
At RSM, we offer a competitive benefits... For full info follow application link.
RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.
