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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 50640261 |
Description Activated On: 4/7/2026 2:11:05 PM |
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. The purpose of this position is to ensure consumer protection by examining health insurance companies for compliance with complex state and federal health insurance laws and regulations. |
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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. The duties performed by the employee in this position during a Market Conduct Examination (on-site or in-house), limited scope target examination, study or continuum project (hereinafter referred to as “Market Conduct Project”) are performed under the guidance of the supervisor or higher- level examiner and include: 1. Assist in creating the examination data call and other data requests to insurance companies. 2. Assist in applying proper random sampling methods to acquire a random sample of adequate size to establish statistics needed to evaluate an insurance company in business areas such as claims, complaints, and policyholder services. 3. Assist in preparing interview questions and conducting interviews of insurance company representatives to learn about company practices. 4. Review insurance companies’ files and electronic records, such as policy forms, claims, consumer complaints, underwriting and rating practices, marketing and sales materials, producer licensing, operations and management, policyholder services information, etc., to determine compliance with complex Pennsylvania and federal statutes and regulations, including Pennsylvania benefit mandate statutes, the Affordable Care Act (ACA), and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). 5. Assist in developing tools to assess compliance with the requirements of the MHPAEA. 6. Assist in performing analysis to determine compliance with the requirements of the MHPAEA; review and analysis are for compliance with requirements related to both financial requirements/quantitative treatment limitations (FR/QTLs) and non-quantitative treatment limitations (NQTLs). 7. Participate in discussions with the Deputy Commissioner and Department Legal Counsel regarding exam status and issues. 8. Identify violations of statutes and regulations and secure and retain copies of documentation and evidence to support findings of violations. 9. Prepare written summary reports to communicate results of market conduct projects to companies and ultimately prepare the final examination report and consent order for issuance to companies. 10. Review and evaluate company responses to initial findings. 11. Draft information requests to companies and assist in preparing reports of findings from market conduct exams. 12. Participate in meetings with insurance companies and vendors. 13. Assist in Identifying and recommending corrective action necessary for insurance companies to remediate consumer harm as well as to address and correct findings of non-compliance. 14. Assist in preparing penalty calculation data and assist in preparing exam findings presentations for discussion with the Deputy Commissioner and Commissioner. 15. Assist in developing and conducting presentations related to the MHPAEA for Department staff, other state insurance departments, and federal agencies. 16. Engage in exam compliance monitoring projects, to include ongoing review of restitution paid, and corrective action implemented, by companies. 17. Attend and testify at administrative hearings to support findings of projects as necessary. 18. Participates in, or attends, various workshops, NAIC working group meeting, IRES presentations, etc. 19. Perform other duties and special projects as assigned or required. |
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. Work is performed under the guidance of the supervisor or higher-level examiner and is reviewed for conformance to program standards and written expectations. Subsequent to initial training, the incumbent independently reviews companies’ files and records; identifies violations of statutes and regulations; reviews company responses to findings; and generates information requests, written summaries, work papers, spreadsheets, charts, tables, and forms. |
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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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