Healthcare Market Conduct Examiner

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Healthcare Market Conduct Examiner

Risk & Regulatory Consulting, LLC

(Regulatory Insurance)

Work from home-any US location

Position Overview
The Market Conduct Examiner will be responsible for performing reviews of major insurance companies’ operations, marketing, underwriting, rating, policyholder service, producer licensing, complaint handling and claims handling processes to verify compliance with states’ insurance statutes and regulations.

Specific Duties and Responsibilities

(Responsibilities may vary slightly depending on seniority level)

• Perform comprehensive, targeted and risk focused market conduct examinations to determine compliance with states’ insurance statutes and regulations on behalf of state insurance departments.
• Review and assess insurance company’s documentation and data to determine compliance with states’ insurance statutes and regulations.
• Draft examination work papers in an organized manner for supervisory review.
• Assist with the preparation of reports, exhibits, and other supporting documentation and schedules that detail a company’s compliance with insurance statutes and regulations and recommend solutions.
• Submit draft examination reports and other deliverables for supervisory review.
• Recommend/document actions to ensure compliance with insurance statutes and regulations.
• Must possess knowledge of and provide guidance of insurance laws, rules, and regulations.
• Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to determine compliance with states’ insurance statutes and regulations and interpret their meaning and determine impact to the insurance company.
• Analyze reports and records relating to specific and overall operations of insurance companies; prepare clear, complete, concise, and informative compliance reports of condition of insurance companies for supervisory review.
• Consistently enhance knowledge of: principles, practices, techniques, and methods of insurance examination and regulations; insurance laws and Insurance Commissioner’s rulings; and related Attorney General Opinions and court decisions; insurance company practices; statistical sampling procedures; basic mathematics.

Requirements

• Bachelor’s Degree in Business, Risk Management, Accounting or Finance; MBA and/or professional certification/s preferred
• Minimum of 7+ years of insurance experience with a State or Federal agency, insurance company, examination firm or with a public accounting firm as …