See Functional Program Analyst 3.

Positions at this level supervise subordinate analysts and/or function as a recognized technical expert responsible for the overall planning, auditing, and/or investigation of health care contractors, health care maintenance organizations, insurers, insurance licensees, and/or other regulated entities.  

Plans, directs, coordinates and reviews the work of subordinate audit, investigative, or compliance staff; 

Conducts audits and/or market conduct examinations, analyzing results and writing reports; monitors the quality and quantity of work performed and conducts quality assurance reviews; 

Confers with executives, compliance staff, accountants and attorneys of insurance companies for purpose of reviewing findings and recommended changes; confers with and reports to Chief Examiner/Investigator as to principles, practices and procedures of insurance companies relating to sales, advertising, underwriting, rating and claims; 

Represents the division on boards and committees, both within and outside of the agency; speaks at community meetings and forums; 

Analyzes insurance forms, policies and programs submitted by companies writing unusual coverage or special classes of business; 

Oversees the research and investigation of consumer complaints and mediates disagreements; 

Identifies complaint trends or patterns, or other evidence of unfair, inequitable or unlawful insurance practices; recommends or refers such practices or individual cases/files for enforcement action; 

Reviews, researches and investigates the most complex contracts, filings, or inquiries that involve compliance issues related to laws, regulations or departures in industry practices.

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position. 

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

Positions typically require a Bachelor’s degree in business administration, social work, public health, public administration, or related field, and three years of related professional work experience in areas such as regulatory examinations; insurance underwriting, compliance, rating, or claims; health care consumer issues; or health care benefit plan design, distribution, or administration, including supervisory experience.