JOB TITLE: INSURANCE MARKET CONDUCT EXAMINER 1

JOB CODE: 04092

SERIES NATURE OF WORK: The Insurance Market Conduct Examiner job series describes work in the regulation of market conduct activities of insurance companies and other licensees of the Pennsylvania Insurance Department.

DEFINITION: This is professional work in the examination of insurance company and insurance licensee operations or in the conduct of insurance market analysis projects to determine compliance with market conduct insurance laws and regulations.

An employee in this job conducts assigned sections of insurance market conduct examinations to ensure business practices comply with insurance laws and regulations or participates in conducting insurance market analysis projects to identify market conduct issues and trends. Work is performed under the guidance of the supervisor or higher level examiner and is reviewed for conformance to program standards and written expectations.

Market conduct examination work involves examining assigned segments of insurance companies’ operations by collecting and analyzing records, files, and data from insurance companies and licensees to detect unlawful practices and trends related to underwriting and claims practices, advertising and billing procedures, licensing, policy form filings, and the handling of consumer complaints; determining compliance with statutes and regulations; preparing initial summaries of findings for assigned sections of examinations; and evaluating company responses to initial findings. Work may also involve independently conducting oversight compliance reviews involving limited scope desk examinations.

Market analysis project work involves conducting assigned segments of the annual market analysis of the insurance industry by obtaining, evaluating, and analyzing insurance company and industry data to identify companies and industry trends that pose regulatory concern and potential harm to consumers; determining compliance with statutes, regulations, and policy conditions; and preparing summaries of findings. Work may also involve participating in conducting industry studies and surveys on compliance issues.

DISTINGUISHING CHARACTERISTICS:

Work is differentiated from the Insurance Company Examiner job series by the type of review. The Insurance Company Examiner series focuses on auditing and accounting work in the examination of financial conditions and operations of insurance companies whereas the Insurance Market Conduct Examiner series focuses on the examination of market conduct activities.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.):

Participates in market conduct examinations of insurance company and insurance licensee operations to determine compliance with laws and regulations and to detect industry practices that may adversely impact consumers.

Prepares data requests for insurance companies selected for examination and evaluates submitted data to ensure accuracy and relevance to examinations.

Evaluates claims processing procedures to ensure claims are handled appropriately, analyzes data to identify trends in claim payments, identifies procedural problems, and develops recommendations for corrective action.

Reviews records and documents related to rating and underwriting practices, advertising and billing processes, and policy form filings to determine compliance with statutes and regulations; secures necessary documentation to support finding; and makes recommendations for corrective action.

Ensures insurance producers hold appropriate and active licenses.

Reviews companies’ consumer complaint handling processes and complaint registers, obtains samples of consumer complaint cases, analyzes information to determine compliance with statutes and regulations, and develops recommendations for corrective action.

Conducts limited scope market conduct examinations, which focus on limited aspects of an insurance company’s business.

Prepares reports of findings or portions of reports of findings.

Researches insurance statutes and other sources to determine which penalties can be assessed against insurance companies and other licensees for non-compliance with commonwealth insurance laws.

Participates in oversight of targeted examination results by reviewing insurance companies’ and other licensees’ reports of restitution, claims payments, and other documents to facilitate and ensure implementation of agreed upon resolutions to violations of commonwealth insurance laws.

Participates in conducting various types of market analysis reviews by researching records, applying survey methods, analyzing market conduct data, identifying anomalies, and preparing summaries and reports of findings.

Conducts various research in support of multistate market conduct examinations.

Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

Knowledge of insurance principles, practices, and terminology.

Knowledge of insurance laws, rules, and regulations.

Knowledge of analytical and evaluative methods and techniques.

Knowledge of the use and functionality of standard computer software such as word processing, spreadsheet, and e-mail programs.

Ability to analyze and interpret laws, rules, regulations, policies, and procedures.

Ability to read and interpret written and numerical information.

Ability to prepare clear and comprehensive written reports.

Ability to communicate effectively in writing.

Ability to communicate effectively orally.

Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities):

Successful completion of the Insurance Market Conduct Examiner Trainee training program;

or

One year of professional experience in insurance market conduct examinations, insurance company financial examinations, insurance investigations, insurance financial analysis, insurance underwriting, insurance policy review and analysis, insurance claims administration, or insurance sales, and a bachelor’s degree;

or

An equivalent combination of experience and training.