6/8/2010 04091

MARKET CONDUCT EXAMINATION CHIEF, INSURANCE

DEFINITION: This is managerial work in planning, directing and evaluating a market conduct examination program in the Insurance Department.

An employee in this job plans, directs and evaluates the activities of a market conduct division. Work involves managing the program to perform examinations of insurance company's records, files, and practices to determine their compliance with Pennsylvania's statutes and regulations. Work also includes supervising the collection and analysis of data from insurance companies and agencies to detect unlawful practices in regard to claims processing, underwriting practices, advertising, billing procedures, rates, forms, and handling of consumer complaints. An employee develops a market conduct examination schedule, identifies specific market issues to be reviewed and determines examination methodology. An employee also formulates and recommends policies and procedures to govern a market conduct program. Supervision is exercised over a professional and clerical staff. Work assignments are generated by the receipt and review of data submitted by insurance companies. An employee formulates the manner in which work is carried out by staff and independently directs staff in the completion of work products. The completed work is reviewed by an administrative supervisor for soundness of findings through reports, correspondence and conferences.

EXAMPLES OF WORK: Plans, directs and evaluates the activities of a market conduct division.

Manages a program to examine insurers to detect and eliminate unlawful industry practices that may impact policyholders.

Supervises the collection and analysis of data from insurance companies and insurance agencies to detect unlawful practices in claims, underwriting practices, advertising, billing procedures, rates, forms, and the handling of consumer complaints.

Supervises compliance reviews, studies and continuum projects to determine industry practices and trends in certain areas of the market.

Develops a market conduct examination schedule, identifies specific market issues to be reviewed and determines examination methodology.

Reviews and edits reports of market conduct examinations for structure, uniformity, clarity and accuracy of technical citations, interpretations and recommendations.

Formulates and recommends policies and procedures to govern a market conduct program.

Meets with insurance company officials and representatives to conduct entrance and exit conferences, including discussions of examination purpose, format, results, findings of deficiencies and recommendations for corrective action.

Performs the full range of supervisory duties.

An employee in this job may participate in the performance of subordinates’ work consistent with operational or organizational requirements.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of insurance principles and practices.

Knowledge of insurance laws, rules and regulations.

Knowledge of insurance claims practices and procedures.

Knowledge of insurance underwriting practices and procedures.

Knowledge of the principles and practices of insurance rate-making, including the return of net premium.

Knowledge of operational auditing principles and practices related to auditing and examining insurance company documents and records.

Knowledge of data collection and analysis techniques.

Knowledge of the content, format and use of insurance company forms, records and documents.

Knowledge of scientific sampling methods.

Ability to analyze records and documents to ensure compliance with Commonwealth statutes and regulations.

Ability to evaluate and interpret insurance laws and regulations.

Ability to establish and maintain effective working relationships.

Ability to communicate effectively orally.

Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING: Two years as an Insurance Market Conduct Examiner 2;

or

Five years of professional insurance market conduct examination experience and a bachelor's degree;

or

Five years of professional insurance underwriting or investigation experience and a bachelor's degree;

or

An equivalent combination of experience and training that includes four years of professional experience in market conduct examination or insurance underwriting or investigation.