Pharmacy Benefit Manager Licensing & Consumer Services Investigator

The Vermont Department of Financial Regulation (DFR) seeks a Pharmacy Benefit Management (PBM) Licensing & Consumer Services Investigator, focusing on PBM licensing, third-party administrator (TPA) licensing, consumer and pharmacy complaints, and ensuring industry compliance with PBM and TPA regulations that directly impact benefit services provided to Vermonters.When applying, please be sure to upload a cover letter as well as your resume.

In this role, you will:

• Review and analyze PBM and third-party administrator license applications and renewals promptly and accurately, ensuring compliance with regulatory requirements.
• Receive, investigate, and process consumer and pharmacy complaints.
• Assist with the development of and conduct and execution of public outreach programs and educational materials to inform consumers about their rights and responsibilities in the complex realm of healthcare and prescription drug delivery.
• Facilitate training sessions for other divisions within the department on emerging trends and challenges in PBM licensing and consumer protection.
• Maintain detailed records of investigations, findings, and enforcement actions related to PBM licensure, and preparing comprehensive reports for submission to the DFR and other regulatory authorities; and
• Perform other regulatory duties as needed.

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, Pharmacy Benefit Manager Licensing & Consumer Services Investigator (Job Requisition #52297), 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 training, public outreach, or regulatory meetings. The role may involve handling sensitive consumer complaints and engaging in discussions with industry representatives, requiring tact and professionalism. The position may require work outside of normal business hours to meet regulatory deadlines.

Four (4) years of experience in regulatory compliance, consumer protection, insurance investigation, healthcare administration, or a related field, including two (2) years in a supervisory or lead investigative role.

OR

Two (2) years or more as a regulatory investigator, compliance analyst, or similar position focusing on Pharmacy Benefit Management, Third-Party Administration, or Mental Health Review Agents.

* Associate Professional in Insurance Regulation (APIR)
* Professional in Insurance Regulation (PIR)
* Market Conduct Manager (MCM)

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.