JOB TITLE: INSURANCE MARKET CONDUCT EXAMINER 2

JOB CODE: 04093

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 advanced 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 serves as Examiner-in-Charge of insurance market conduct examinations that are conducted to ensure business practices comply with insurance laws and regulations, or conducts insurance market analysis projects to identify market conduct issues and trends. Work may involve independently conducting examinations and providing on-the-job training and guidance to lower level examiners. Work is performed independently using initiative and judgment under the general direction of the supervisor, who reviews work through conferences and reports for conformance to program standards.

Examiner-in-Charge work involves serving in an administrative and technical oversight role, with responsibility for coordinating and managing on-site examinations including determining the scope of examinations; conducting entrance and exit conferences; overseeing the collection and analysis of records, files, and data; preparing exit summaries and examination reports for issuance to insurance companies and licensees being examined; and serving as the primary liaison to the insurance companies and licensees. Work may also involve conducting oversight compliance reviews.

Market analysis project work involves conducting 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; determining which companies require further review; and drafting the Market Regulation Committee Report. Work may also involve developing and conducting industry studies and surveys on compliance issues.

DISTINGUISHING CHARACTERISTICS:

Examiner-in-Charge work is differentiated from the next lower level job by the responsibility for serving as Examiner-In-Charge and preparing exit summaries and examination reports.

Market analysis project work is differentiated from the next lower level job by the greater independence and the responsibility for determining which companies require further review, drafting the Market Regulation Committee Report, and developing and conducting industry studies and surveys.

Work is differentiated from the Insurance Company Examiner job series by the type of review. The Insurance Company Examiner series focuses on 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.):

Serves as Examiner-In-Charge by leading a group of examiners in the conduct of examinations including planning, organizing, scheduling, assigning, and reviewing work.

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

Determines data sample sizes, adequacy of samples, and when to increase sample size in regard to records and files.

Assigns portions of examinations to lower level examiners; reviews reports and recommendations made by examiners; and prepares the comprehensive examination reports including recommendations for appropriate action.

Provides guidance to lower level examiners on rules, regulations, policies, standards, and objectives of the examination process.

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.

Reviews records related to restitution payments.

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.

Prepares reports of findings and coordinates the compilation 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.

Oversees 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.

Conducts baseline analysis reviews and market analysis reviews by researching records, applying survey methods, analyzing market conduct data, identifying anomalies, and preparing reports of findings.

Develops and conducts industry studies and surveys to identify trends in business practices.

Leads and participates in multistate market conduct examinations.

Presents evidence and testifies at hearings.

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):

One year as an Insurance Market Conduct Examiner 1;

or

Two years 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.