Market Conduct Examiner

Market Conduct Examiner

The Montana State Auditor, Commissioner of Securities and Insurance (CSI), protects Montanans by regulating two of the state's largest industries—securities and insurance. CSI works to foster a thriving marketplace through education, common-sense regulation, and equitable enforcement of the law to support consumers, businesses, and a fair insurance market.

This position helps protect consumers by analyzing insurer market activity, conducting market conduct examinations, reviewing health insurance carrier network adequacy, and assisting with pharmacy benefit manager licensing compliance work.

The successful candidate will perform independent compliance and examination work involving insurance company business practices, applicable statutes and rules, and regulatory reporting. The role supports fair competition in the insurance marketplace and helps identify violations, trends, and business practices that may harm Montana consumers.

This is an on-site position located in Helena, Montana.

State of Montana benefits, including retirement, health insurance options, paid leave, and predictable hours – a total compensation package delivering great benefits, financial security, and a retirement you can count on.

State of Montana employment may qualify you to receive student loan forgiveness under the Public Service Loan Forgiveness. Look here to learn more and understand whether or not you may qualify.

Key responsibilities of this position include:

• Conduct baseline and in-depth market analyses using NAIC and state regulatory guidance to identify trends, outliers, and insurer activity requiring additional review.
• Document findings, prepare reports, spreadsheets, and recommendations, and support regulatory follow-up when potential violations or compliance concerns are identified.
• Conduct health insurance carrier network adequacy reviews to verify sufficient access to covered providers and services and evaluate compliance with applicable state standards.
• Perform full-scope and targeted market conduct examinations and/or investigative reviews of insurers to review complaint handling, producer licensing, marketing and sales, policyholder service, underwriting and rating, and claims practices.
• Analyze company records, data submissions, business practices, and operational materials; identify potential violations; and help develop recommendations for corrective action.
• Work with legal and internal division staff on examination and investigation support, information gathering, enforcement referrals, and final reports.
• Review pharmacy benefit manager licensing materials for compliance with Montana insurance laws and communicate with applicants regarding deficiencies or needed corrections.
• Participate in training, special projects, multi-state coordination, and other duties assigned in support of bureau and division goals.

The strongest candidates will bring many of the following qualifications and strengths; however, not every candidate will possess all of them, and applicants with closely related experience are encouraged to apply:

• Ability to interpret and apply statutes, rules, policies, and regulatory guidance to complex factual situations.
• Experience reviewing business practices, contracts, claims, complaint trends, or regulatory materials for compliance issues.
• Strong analytical, investigative, and problem-solving skills, including the ability to organize information and identify patterns, discrepancies, and risk areas.
• Strong written and verbal communication skills, including the ability to explain findings clearly and work with regulated entities, attorneys, executives, and agency staff.
• Ability to manage multiple assignments, meet deadlines, and work independently with sound judgment.
• Proficiency with standard business software and the ability to learn specialized compliance, database, and examination tools.
• Experience as an insurance producer, claims adjuster, paralegal, or investigator; or in a similar role that involves reviewing complex information, applying laws or regulations, and communicating findings.

The position typically requires a combination of education and experience equivalent to a bachelor's degree in business, accounting, or a related field and three years of progressively responsible experience in the insurance industry. Alternate combinations of relevant education and experience may be considered on a case-by-case basis, including experience gained as an insurance producer, claims adjuster, paralegal, investigator, or in other roles with comparable responsibilities and where strong analytical, communication, and compliance skills can be demonstrated.

Candidates must be able to successfully complete Accredited Insurance Examiner (AIE) and Certified Insurance Examiner (CIE) certifications within the timeframe specified upon hire. Professional insurance designations such as CLU or CPCU are preferred.

Helpful experience may include one or more of the following, however candidates are not required to meet all of these to be considered:

• Experience with various lines of insurance, such as property and casualty, life insurance, and disability (health) insurance.
• Insurance regulation, market conduct, claims, underwriting, audits, investigations, or compliance review.
• Work involving health insurance, network adequacy review, producer licensing, or pharmacy benefit manager regulation.
• Reviewing complex documents, data, contracts, or operational records and preparing findings or recommendations.
• Strong Excel skills and experience working with large or complex data sets, including reviewing, organizing, and analyzing data to identify trends, outliers, discrepancies, and potential compliance concerns.
• Experience in roles such as insurance producer, claims adjuster, paralegal, investigator, or compliance positions, particularly where the work involved is analyzing facts, applying insurance laws or regulations, and documenting or presenting recommendations.

This position is not a supervisory position.

Special requirements include successful completion of background and fingerprint checks and possession of a valid driver's license.

Applicants must submit the materials required by the State of Montana Careers process. In addition, to be considered for this position, applicants must submit both a cover letter and resume.

Cover Letter Instructions: Please describe your experience performing audits, reviewing compliance issues, interpreting statutes or regulations, and preparing written findings or recommendations, including any experience specifically related to insurance.

Your application will NOT be considered without these required items.

Important Tip: When uploading and submitting your application materials, please mark your attachments as "relevant" or we will be unable to view them.

Applications missing the requested documents will be considered incomplete and will not progress further in the process. Only electronic materials will be accepted. If you need assistance or accommodation, please contact Human Resources. Applicants claiming employment preference are required to provide proper documentation, i.e. Vet Preference (DD214), Disabled Vet document from U.S. Veterans Administration certifying service-connected disability or purple heart medal, disable (DPHHS Disability Certification), by the closing date. The state of Montana Careers system will generate an email with instructions on how to submit preference documents.