Senior Advisor, Market Conduct (PBM/Health Plan)
Assists with and, as appropriate, takes the lead to facilitate examination activity for MCE issues involving Express Scripts and its affiliated entities as well as EviCore. Partners with other market conduct team members and, as appropriate, takes the lead on examinations to manage requests for information, facilitate responses to requests with business partners, and establish and maintain contacts with key business partners and Department of Insurance and other regulatory examiners. Work in partnership with other market conduct team members to address and/or receive guidance on addressing findings and corrective action plans with business partners and to facilitate resolution of the exam and any proposed fines or penalties.
Key Responsibilities:
Act as Company coordinator for market conduct examinations.
Serve as liaison to insurance department examiners during the examination process.
Assess market conduct issues and findings, communicate company position statements, develop appropriate responses and corrective actions, and work with Managing Counsel to negotiate outcomes to mitigate risk for the Cigna companies.
Collaborate with business partners, including Legal, Regulatory, Account Management, PBM Operations, EviCore and others to ensure MCEs are conducted efficiently.
Complete all pre-examination surveys, data requirements and examination materials in an accurate and timely manner.
Provide responses to examiner requests and criticisms within stated/negotiated timeframes. Utilize Open Pages, iManage and/or other tools, as appropriate.
Act as an advisor/consultant to business partners regarding regulatory examinations.
Communicate market conduct issues and findings, company position statements, and best practices to Legal and business partners.
Assist in the development of practices to address issues and to close compliance gaps and mitigate risk.
Develop business partner relationships to assist in fostering a compliant and efficient environment with mutual ownership.
Assist business partners by providing direction and instruction in responding to MCE requests
Qualifications and Skills:
Bachelor’s degree or equivalent experience
Minimum 5+ years of regulatory, compliance, or market conduct experience within health insurance, PBM, or utilization management (UM) is needed for this role.
Experience supporting or managing market conduct examinations (MCEs) or working directly with Department of Insurance (DOI) regulators and exam processes.
Demonstrated ability to manage regulatory examinations, including coordinating responses, analyzing findings, and supporting corrective action plans
Strong knowledge of PBM and/or UM operations, regulatory frameworks, and business processes
Proven ability to manage complex, regulator-facing matters and drive outcomes
Excellent written and verbal communication skills, with the ability to present company positions to regulators and internal stakeholders
Strong organizational skills with the ability to manage multiple deadlines, requests, and stakeholders simultaneously in a matrixed environment
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 109,600 - 182,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Key Responsibilities:
Act as Company coordinator for market conduct examinations.
Serve as liaison to insurance department examiners during the examination process.
Assess market conduct issues and findings, communicate company position statements, develop appropriate responses and corrective actions, and work with Managing Counsel to negotiate outcomes to mitigate risk for the Cigna companies.
Collaborate with business partners, including Legal, Regulatory, Account Management, PBM Operations, EviCore and others to ensure MCEs are conducted efficiently.
Complete all pre-examination surveys, data requirements and examination materials in an accurate and timely manner.
Provide responses to examiner requests and criticisms within stated/negotiated timeframes. Utilize Open Pages, iManage and/or other tools, as appropriate.
Act as an advisor/consultant to business partners regarding regulatory examinations.
Communicate market conduct issues and findings, company position statements, and best practices to Legal and business partners.
Assist in the development of practices to address issues and to close compliance gaps and mitigate risk.
Develop business partner relationships to assist in fostering a compliant and efficient environment with mutual ownership.
Assist business partners by providing direction and instruction in responding to MCE requests
Qualifications and Skills:
Bachelor’s degree or equivalent experience
Minimum 5+ years of regulatory, compliance, or market conduct experience within health insurance, PBM, or utilization management (UM) is needed for this role.
Experience supporting or managing market conduct examinations (MCEs) or working directly with Department of Insurance (DOI) regulators and exam processes.
Demonstrated ability to manage regulatory examinations, including coordinating responses, analyzing findings, and supporting corrective action plans
Strong knowledge of PBM and/or UM operations, regulatory frameworks, and business processes
Proven ability to manage complex, regulator-facing matters and drive outcomes
Excellent written and verbal communication skills, with the ability to present company positions to regulators and internal stakeholders
Strong organizational skills with the ability to manage multiple deadlines, requests, and stakeholders simultaneously in a matrixed environment
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 109,600 - 182,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.