Positions in this occupational group examine and evaluate insurance practices, contract forms, and/or operations of regulated program entities such as health care service contractors, health maintenance organizations, insurance licensees, life and disability, or property and casualty insurance companies.  Positions analyze and review functional practices, contracts, forms, service agreements, agreements, policies and other materials and provide consultation to insurers, contractors, staff and others.

Positions at this level independently perform professional research and review, analysis, and evaluation of insurance contracts, forms, and other materials and/or the operations of insurers, health care contractors, health maintenance organizations, insurance licensees, or other regulated entities to ensure compliance with federal and state laws and regulations.  Incumbents provide consultative services to service providers, staff, and members of the public.

Conducts field examinations of insurance companies, agents and brokers regarding items such as insurance rates, policy provisions, claims practices and underwriting procedures; 

Researches and investigates consumer complaints and where practicable, mediates disagreements; 

Analyzes insurance practices and/or policy forms and contracts to ascertain if they are in compliance with public policy, laws and regulations, and takes corrective action as necessary; 

Documents audit activities; prepares reports and documentation; provides necessary follow-up for compliance with corrective action plans; 

May represent the department in administrative hearings and other civil actions and testify on findings as required;  

May supervise lower level staff.

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 two years of 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.