Market Conduct Examiner II
State of Nebraska

The work we do matters!

Hiring Agency:
Insurance - Agency 22

Location:
Lincoln, NE

Hiring Rate:
$23.278

Job Posting:
JR2024-00011824 Market Conduct Examiner II (Open)

Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):

Job Description:
This position will perform reviews of contractual provisions between Pharmacy Benefit Managers and Pharmacists as well as coordinate and work with the Legal Division to ensure compliance with the Act. This position will also be tasked with the investigation and referral for prosecutions of PBMs under the Act. This position will assist with licensure and renewals. Other duties include reviewing for compliance as it pertains to maximum allow costs for Pharmacy Benefit Managers, federal law, "gag law" provisions of the act and any willing pharmacist provisions of law.

Look at what we have to offer!

• 13 paid holidays
• Vacation and sick leave that begin accruing immediately
• Military leave
• 156% (that's not a typo!) state-matched retirement
• Tuition reimbursement
• Employee assistance program
• 79% employer paid health insurance plans
• Dental and vision insurance plans
• Employer-paid $20,000 life insurance policy
• Public Service Loan Forgiveness Program (PSLF) through the Federal government
• Wide variety and availability of career advancement as the largest and most diverse employer in the State
• Opportunity to be part of meaningful work and make a difference through public service
• Training and Development based on your career aspirations
• Fun, inviting teammates
• A safe and secure environment

At the State, we stand by our core values of treating others with dignity and respect, acting ethically in all situations, and creating an environment where our customer is our top priority. Apply to join our team today!

Job Duties:

A. Review of Contractual Provisions between PBMs and Pharmacists

B. Review of compliance of audit requirements by PBMs

C. Assist the Legal Division with investigations, referrals and administrative actions

D. Assist Examination Division with licensure and renewal reviews

E. Review PBMs for compliance with MAC pricing

F. Review for compliance with federal law

G. Investigate Complaints against PBMs

H. Review for compliance with any willing pharmacist provisions of the Act I. Review for compliance with "gag law" provisions of the Act

Requirements / Qualifications

Minimum Qualifications: Bachelor's degree in business or related field AND one year of experience in insurance industry or insurance regulation or related field; OR Associate degree in business or related field AND three years' experience in insurance industry or insurance regulation or related field; OR Five years' experience working in insurance industry or insurance regulation or related field.

Preferred Qualifications: Bachelor Degree in Business, Health or related field. Pharmacy Tech Certification. Prior Experience in a Pharmacy and/or Insurance Industry

Other: This position requires travel. As such, the incumbent must be able to present a valid driver's license or another form of reliable transportation. Regular and reliable attendance is required.

Knowledge, Skills and Abilities

Knowledge of: Health Insurance; Claims Procedures; Drug Formularies; Drug Pricing Standards; Pharmacy Claim Submission; PBM Reimbursement to Pharmacies and PBM's Audit of Pharmacies to detect Fraud or Overpayment.


Benefits

We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits

Equal Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.

Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page.