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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00074948 |
Description Activated On: 1/15/2026 9:22:43 AM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Directs, coordinates, and supervises a national program to determine compliance with complex state and federal Health Insurance laws and regulations through market conduct examinations, market oversight reviews, studies, and the use of other regulatory tools available through the continuum of regulatory responses. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. 1. Supervises and directs activities of the Health Market Conduct Division, including scheduling staff assignments and providing training. 2. Handles personnel matters and administration of examiners. Exercises authority and discharges these responsibilities through the examiner-in-charge assigned to each specific examination. 3. Plans, directs, and supervises various types of Health Insurance market conduct examinations, including complex Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAEA) exams. 3. Identifies specific market issues, including developing emerging trends and/or non-compliance, and targets companies to monitor the insurance market. Identifies potential companies to be examined and submits recommendations to the Director of Bureau. 4. Identifies necessary information and methodology, including required documents, to determine compliance by market oversight review. 5. Prepares work plans for each market conduct examination and market oversight review prior to beginning exams. 6. Prepares exam announcement letters and other correspondence to insurance company officials. Supervises the preparation of exam data calls. 7. Establishes an examination schedule and assigns priorities in order to respond to areas of concern. 8. Ensures exams are entered in NAIC MATS and RIRS systems. 9. Supervises the development and alteration of MHPAEA testing tools. 10. Develops and conducts MHPAEA presentations in order to provide compliance guidance to health insurance companies. 11. Conducts entrance and exit conference with examined companies. 12. Reviews and edits reports of examination for structure, uniformity, clarity, and the accuracy of technical citations and/or interpretations. 13. Oversees exam penalty calculations and makes recommendations to Bureau Director and Deputy Commissioner regarding final penalty amount. 14. Prepares for and conducts settlement meetings with insurer representatives regarding the content of the report of examination and any corrective action needed as a result of examination. 15. Drafts Consent Orders, as appropriate, and negotiates settlement to reach closure. 16. Develops and conducts presentations on exam findings for other Insurance Department staff, including the Bureau Director, Deputy Commissioner, Commissioner, Legal staff, Press/Communications staff, Legislative staff, Consumer Services staff, and Product Regulation staff. 17. Prepares executive summaries of completed market conduct exams and provides input on exam press releases. 18. Reviews and recommends proposed legislation and assists in the development of Departmental regulations. 19. Represents the Division/Bureau at local and national meetings regarding insurance problems and solutions. Presents information to other states and the U.S. Department of Labor regarding the Department’s MHPAEA enforcement activities. 20. Prepares for and participates in bi-weekly meetings with the Legal Department, as well as bi-weekly meetings with the Commissioner. 21. Prepares monthly, quarterly, and annual reports; provides information for budget processes. 22. Attends monthly NAIC/CCIIO calls, weekly Health Reform calls, weekly Health Issues Roundtable calls, weekly department behavioral health check-in call, and NAIC MHPAEA working group calls. 23. Monitors exam budgets and exam vendor work/budgets; ensures exam cost transparency requirements are followed. 24. Performs other duties and related work as assigned or required, including handling and directing special assignments. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. In supervising Health Market Conduct examinations, oversight compliance reviews, industry studies, and other continuum projects, the employee receives work assignments as well as the scope and objectives of the assignments directly from the Bureau Director. The employee determines the needed activities for the team examiners to complete the examinations in a timely fashion. The employee performs job objectives with minimal supervision. The employee provides input to the Bureau Director on department policy decisions. Close coordination is maintained with the Bureau Director and peer department staff. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. N/A 5. N/A 6. N/A |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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