Lead Insurance Examiner – ACA Forms & Plan Management

About the role

The State Corporation Commission’s Bureau of Insurance seeks two Lead Insurance Examiners for the ACA Forms and Plan Management section in the Life & Health Insurance Division. One position oversees three insurance professionals handling ACA and large group health insurance filings and other group accident and sickness filing reviews. The other oversees two professionals reviewing applications for carriers to participate in Virginia’s health insurance marketplace and reviewing ACA and non-ACA group health insurance policy forms. The section ensures filings comply with Virginia insurance laws and regulations.

Responsibilities

• Lead, coach, mentor, develop, and evaluate assigned staff.
• Assist section manager in training staff and coordinating and monitoring staff workload.
• Audit rate and form filing reviews handled by staff and address any training needs identified through these audits.
• Serve as a subject matter expert and resolve complex analytical or technical issues.
• Participate in the development of policies, procedures, and guidelines.
• Provide verbal and written advice and comment on compliance issues for filings.
• Communicate verbally and in writing with regulators, industry personnel, and the public in response to requests for information, interpretation of contract provisions and laws, or review of staff decisions.
• Correspond and meet with companies to obtain information, corrections, and amendments.
• Provide technical, policy implication, and fiscal impact comments on specific issues related to proposed and enacted legislation impacting the review of ACA products, large group health filings and other group accident and sickness product filings.
• Serve as a liaison with other sections and agencies.
• Lead projects and prepare complex reports.
• Lead and participate in meetings.
• Perform related work as required.

Qualifications

• Six (6) or more years of professional experience with health insurance product filings, including compliance with ACA requirements.
• Considerable knowledge of ACA and group accident and sickness insurance products.
• Considerable knowledge of insurance terminology, laws, and regulations.
• Ability to effectively lead, manage, coach, develop, train, and evaluate staff.
• Ability to read, review, and analyze insurance policies, related forms, and information related to form and rate filings.
• Ability to read, understand, and interpret sections of the Virginia Insurance and Administrative Codes and correctly determine their applicability to submitted form and rate filings.
• Ability to effectively analyze issues or situations, consider viable options, and make sound recommendations.
• Exceptional verbal and written communication skills.
• Strong attention to detail and critical thinking skills.
• Proficiency in general office software applications and programs such as SERFF.
• Ability to proactively recommend changes and to lead process improvement efforts.
• Ability to meet tight deadlines.
• Ability to establish and maintain effective working relationships with Commission staff, industry personnel and other state and federal agencies.

Pay

Starting Salary Range: $88,275 - $95,500

Schedule

Hybrid work schedule (typically 2 days in office and 3 telework days each week)

Benefits

Variety of professional development and training opportunities.