Market Conduct PBM Examiner

at State of Vermont in Montpelier, Vermont, United States

Job Description

The Vermont Department of Financial Regulation is seeking a Market Conduct PBM Examiner to monitor and regulate Pharmacy Benefit Managers (PBMs) operating in Vermont. This is an opportunity to take a leading role in the Vermont's newly regulated PBM market. This position conducts examinations and investigations of PBMs and third-party administrators (TPAs) to assess compliance with Vermont laws and regulations..

The work involves reviewing PBM contracts with health plans and pharmacies, analyzing pharmacy claims data, writing comprehensive reports on findings, and working with entities on compliance plans. The ideal candidate will have experience with PBM operations and/or pharmacy claims, strong communication skills, experience interpreting laws and regulations, and be comfortable in potentially adversarial situations.

If you are motivated by helping others and believe in public service, this is an opportunity to join a team dedicated to serving Vermonters.

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.