· Personnel Home · MQ’s · Index · Examination Code: R ·
Nature of Work
Under general supervision, performs entry level professional work in the
market conduct examination of the business practices, policies and rates of
insurance companies, resident agents, brokers, non-resident agents, third
party administrators, insurance agencies and other regulated entities to
ensure compliance with applicable laws and regulations. As part of an on-site
market conduct examination team, examines insurance company records, files and
practices. May be assigned a specialty area in large, complex examinations.
Prepares assigned sections of the final examination report. On-site market
conduct work requires extensive travel in and outside West Virginia.
Assignments may range from three weeks to six months. Reimbursement for time
and expenses incurred traveling to and from examination site is limited to one
trip every two weeks. Performs related work as required.
Distinguishing Characteristics
This is the entry level in the Market Conduct Examiner series. Employees
assigned to this class are expected to acquire the work specific knowledge,
skills and abilities to function as a Market Conduct Examiner. As technical
proficiency is acquired, incumbent will be expected to demonstrate progress
toward Accredited Insurance (AIE) designation within a specified time period.
Examples of Work
Essential Job Functions - Any specific position in this class may not include all of
the duties listed, nor do the examples listed cover all of the duties which may be
assigned.
Participates in market conduct examinations of insurance companies and
insurance agent operations to determine compliance with insurance laws
and regulations.
Reviews agent listing compliance, volume of complaints, category of
complaints, number of settlements in each complaint category, number of
hearings in each complaint category, advertising compliance and claims
administration practices.
Reviews records and practices relating to policy form filings for adherence to
insurance laws and regulations.
Reviews license applications to determine compliance with state agent
licensing requirements.
Reviews settlement of claims paid to clients to assure compliance to policy
provisions.
Informs supervisor of findings of non-compliance and suggest appropriate
corrective actions to recommend to the Insurance Commissioner.
Recommends additional investigation of insurance company's financial status or
new policies and rates to ensure solvency and compliance with insurance
regulations.
Drafts reports and summaries of investigations and examinations.
Requests subpoenas to obtain information from insurance companies, agents,
brokers or agencies.
Knowledge, Skills and Abilities
Knowledge of the business practices and procedures of insurance companies,
brokers, agents, underwriters and adjusters.
Knowledge of federal and state laws, rules and regulations relating to the
insurance industry.
Knowledge of insurance underwriting and claims procedures.
Knowledge of the records maintained by insurance companies.
Knowledge of operational auditing principles and practices relating to the
auditing and examining of insurance company documents and records.
Knowledge of database and spreadsheet applications.
Ability to compile and analyze data and draw conclusions on insurance
practices, policies and rates of regulated entities.
Ability to interpret and comprehend insurance-related data.
Ability to interpret contractual provisions of insurance policies.
Ability to maintain effective working relationships with other employees,
industry representatives and the general public.
Ability to use a personal computer.
Ability to convey ideas clearly and concisely in business correspondence and
reports.
Ability to communicate effectively, orally and in writing.
Minimum Qualifications
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Training:
Bachelor's degree from a regionally accredited four-year college or
university.
Substitution:
An insurance certification of Chartered Property Casualty
Underwriter (CPCU), Chartered Life Underwriter (CLU), or Fellow Life
Management Institute (FMLI) OR experience as described below may be
substituted for the required training on a year-for-year basis.
Experience:
Five years of full-time or equivalent part-time paid experience as
an insurance agent, broker, examiner, adjuster, underwriter, premium
auditor or investigator with an insurance company or insurance
regulatory agency in the areas of life, accident and health, or property
and casualty.
Established: 12/18/08
Effective:
02/01/09