Auditor-2025-30

Job Description 1. Minimum Candidate Qualifications

The candidate must have a minimum of:

A-1. Either a Bachelor’s Degree or higher in accounting, auditing, economics, econometrics, business economics, finance, financial administration, mathematics, applied mathematics, mathematical sciences, statistics, actuarial science or taxation.

OR,

A-2. A Bachelor’s Degree or higher including or supplemented by 24 semester credit hours in accounting, auditing, economics, econometrics, business economics, finance, financial administration, mathematics, applied mathematics, mathematical sciences, statistics, actuarial science or taxation.

B. Two years of experience in regulatory compliance related to pharmacy and/or medical benefits

C. Eligible to work in New York State.

• Job Description and Required Services:
  
  

Financial Examiner for the Pharmacy Benefits Unit of the Health and Pharmacy Benefits Bureau performs comprehensive reviews of pharmacy benefit managers licensed by the state of New York to ensure compliance with New York Insurance rules, laws and regulations and ensures that pharmacy benefits managers are compliant with regulatory standards and operate with the best interests of both policyholders and consumers in mind. The financial examiner conducts complex audits and examinations involving pharmacy benefit managers (PBMs), prescription drug benefits, and health insurance operations. The role focuses on evaluating regulatory compliance, contract adherence, financial integrity, and operational control related to pharmacy and medical benefits. The ideal candidate will have experience auditing PBMs, health plans, insurers, or third-party administrators, with a strong understanding of drug pricing, rebates, and claims adjustments.

In addition, the candidate must possess and/or have the ability to:

• Have knowledge of Generally Accepted Accounting Principles (GAAP) and Statements of Statutory Accounting principles (SSAP);
• Research and consistently apply state laws, department regulations, National Association of Insurance Commissioners (NAIC) statutory accounting practices, and Federal Deposit Insurance Corporation (FDIC) regulations and practices;
• Knowledge of exam planning procedures, internal controls, sampling techniques, testing procedures, work paper preparation/documentation
• Review procedures and report writing;
• Knowledge of financial analysis techniques and ratios;
• Understand and evaluate enterprise risk management, functions of insurers and pharmacy benefit managers;
• Think critically and make decisions based on reasonable and timely analysis;
• Understand and evaluate risks as well as risk mitigation strategies and controls;
• Multi-task and manage time effectively;
• Work and contribute to a team environment;
• Strong communication skills (both written and verbal);
• Participate in presentations, discussions of examination findings;
• Adapt to complex and rapidly changing expectations and environments;
• Proficiency in MS Excel, Word and Outlook and MS Teams.
• Have familiarity with pharmacy benefit managers and/or health plans
• Ability to review and test contracts between pharmacy benefit managers, insurers, health plans, pharmacies and manufacturers.
• Ability to analyze pharmacy and medical claims to identify discrepancies, risk and non compliance.
• Stay current on regulatory developments affecting pharmacy benefits, health insurance, and managed care.