Successful Strategies for Market Conduct Reviews From the Compliance Officer’s and Regulator’s Viewpoints

Market conduct audits are an opportunity for health insurance plans to demonstrate the effectiveness of their corporate compliance programs. In this webinar, industry leaders and regulators will share effective strategies that work for successful onsite reviews including preparation and data/document production, interacting with auditors, communicating with senior managers, and developing corrective actions.

Educational Objectives:

Attendees will gain a detailed overview of a Market Conduct Review. Attendees will also gain insight into the regulatory, organizational and process changes experienced throughout multiple reviews. Our speakers will take a closer look at:

1. Structure of an Examination
2. Experience of an Examination
3. Changes in the industry landscape
4. Factors in a successful review

Who Should Attend:

• Health insurance professionals who are responsible for any aspect of compliance in their day-to-day career
• Leadership engaged in compliance and regulatory outreach and advocacy strategies
• Health plan compliance and risk management professionals
• Attorneys and legal staff
• Health care consultants

Agenda

2:00 pm – 2:05 pm	Introduction
2:05 pm – 2:35 pm	Mark Hooker: “So You’re Being Examined: What Now?”
2:35 pm – 2:55 pm	Emery Hill: “Successful Strategies for Market Conduct Reviews: The CareFirst Perspective”
2:55 pm – 3:05 pm	Jeff Thomas: “Considerations for Managing a Multistate Examination”
3:05 pm – 3:30 pm	Q&A

Faculty:

Emery Hill, Manager of External and Regulatory Audits, CareFirst BlueCross BlueShield
Mark A. Hooker, CIE, CPCU, MCM, FLMI CWCP, AAI, AU, AIS, LUTCF, Chief Market Conduct Examiner, State of West Virginia Offices of the Insurance Commissioner
Jeff Thomas, JD, Attorney, Mitchell, Williams, Selig, Gates, & Woodyard, P.L.L.C.

Faculty Biographies:

Emery Hill has over 25 years’ experience in health insurance, which he gained in various capacities at CareFirst BlueCross BlueShield and BlueCross Blue Shield Association. In his current capacity as Manager of External Audit Coordination at CareFirst, he is responsible for the oversight and coordination of group and regulatory audits. Prior to his current position, he held various positions in BlueCross BlueShield Association’s Chicago and Washington, D.C. offices. His primary responsibility was for audit resolution activities related to The U.S. Office of Personnel Management audits of participating Blue Cross and Blue Shield Plans, the FEP Director’s Office, and pharmaceutical vendors contracting with FEP. Additionally, he managed activities in support of legal counsel’s defense of audit issues heard before the Armed Services Board of Contract Appeals.

Mark Hooker began his insurance career with the Southern Farm Bureau group, where he became a multiple-year recipient of the company’s “Round Table” and “All-Star” awards. He was later employed as an underwriter and senior underwriter with West Virginia’s state workers compensation fund. He began his regulatory work as a Market Conduct Examiner with the State of West Virginia in 2002. Since then he has assumed the roles of Chief Market Conduct Examiner and Market Analysis Chief. Mark has been an active Participant in the NAIC Market Conduct Examination Standards, Market Analysis Procedures and Market Actions Working Groups. He currently holds the Certified Insurance Examiner (CIE), Chartered Property and Casualty Underwriter (CPCU), Fellow Life Management Institute (FLMI), Certified Workers Compensation Professional (CWCP), Market Conduct Management (MCM), Accredited Advisor in Insurance (AAI), Associate in Underwriting (AU), Associate in Insurance Services (AIS), and Life Underwriting Training Council Fellow (LUTCF) designations. He currently is the IRES Secretary, serving on the IRES Executive Committee and chairing the Education Committee Chairman. Mark is also an Ex-Officio member of the IRES Foundation Board.

Jeffrey Thomas chairs the Insurance Regulatory Practice Group of Mitchell Williams, a law firm with offices in Little Rock, Northwest Arkansas, Austin, New York and Washington, D.C. He provides legal advice on insurance-related regulatory and corporate matters nationwide, representing insurance companies before state and federal regulators in market conduct and compliance investigations. He is a frequent speaker at industry and trade meetings, including the National Association of Insurance Commissioners (NAIC) and Securities Industry and Financial Markets Association (SIFMA).

Registration Rates

Members: $145
Non-members: $175
Government: $125

For information on the Healthcare Compliance Professional^TM designation, click here, e-mail Support@AHIPInsuranceEducation.org or call 800.509.4422.

 

The content presented in this webinar is solely attributable to the speaker and does not represent an endorsement by America's Health Insurance Plans (AHIP) of the accuracy of the information presented in the audio conference or any opinion expressed by the speaker.