Description
Overview
The Vermont Department of Financial Regulation (DFR) seeks a Market Conduct Examiner to monitor and regulate Pharmacy Benefit Management (PBMs) operating in Vermont, and directly contributing to ensuring transparency, fair practices, and consumer protection for pharmacy benefits.
In this role you will:
- Review PBM contracts with health plans and pharmacies for compliance with Vermont laws and regulations.
- Analyze pharmacy claims data.
- Conduct examinations and investigations of PBMs and third-party administrators (TPAs), and makeprovide recommendations to the Directors of Health Insurance Regulation and Market Conduct as toregarding remedial action or administrative actions, and work collaborate with the Legal Division when administrative actions are taken.
- Prepare comprehensive reports based on examination or investigative findings, outlining violations and providing evidence-based recommendations for regulatory actions.
- Perform other regulatory duties as assigned.
The successful applicant will have:
- Basic knowledge of the role, principles, practices and functions of PBMs in the health care system.
- Ability to interpret and apply complex federal and state laws and regulations.
- Ability to communicate effectively, and work in a team setting.
- Ability to establish and maintain effective working relationships in potentially adversarial situations.
This position, Market Conduct Examiner - Pharmacy Benefits (Job Requisition #52353), is open to all State employees and external applicants.
If you would like more information about this position, please contact Jennifer.Egelhof@vermont.gov.
Resumes will not be accepted via e-mail. You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.
Duties are performed primarily in an office setting with the possibility of remote work. Occasional in-state and out-of-state travel may be required for examinations, training, or industry meetings. The role may involve working outside of normal business hours to meet regulatory deadlines. The position requires engagement with PBM representatives, insurers, legal professionals, and policymakers, which may lead to complex negotiations and high-pressure discussions.
Minimum QualificationsFour (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.
Preferred Qualifications• Associate Professional in Insurance Regulation (APIR)
• Professional in Insurance Regulation (PIR)
• Market Conduct Manager (MCM)
• Accredited Insurance Examiner (AIE)
• Certified Insurance Examiner (CIE)
• Any designation specific to health insurance or PBMs
As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits, including:
• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program
Want the specifics? Explore the Benefits of State Employment on our website.
The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State's employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.
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