Insurance Regulatory Analyst I
About The Position
The mission of the North Carolina Department of Insurance is to promote a stable insurance market through unbiased regulation and to protect the lives and property of every citizen in all 100 counties while fostering superior, user-friendly service, courtesy, and respect. Our agency licenses insurance agents, adjusters, bail bondsmen and more, along with investigating fraud matters involving insurance consumers and any entity or individual regulated by the Department. In an ever-changing environment, it is the vision of the Department of Insurance to maintain the stabilization of the insurance industry in order to provide more products, competitive prices and consumer protection. This position currently qualifies for a hybrid telework option with routine office and up to one remote workday per week. The NC Department of Insurance trusts our employees to be self-motivated and successful in hybrid/remote roles. Telework options are subject to change at the discretion of management. The Health Market Analyst supports Market Regulation by collecting, reviewing, and analyzing data from all licensed domestic and foreign insurance entities operating in North Carolina. The primary purpose of this role is to identify early market disruptions and help prevent consumer harm by evaluating compliance with state insurance laws, regulations, bulletins, and related requirements. The analyst conducts detailed analytical studies using various software tools, assists examination teams by procuring and analyzing data, participates in technical projects, and prepares reports sourced from multiple information systems.
Requirements
- Bachelor's degree in business or economics or a related program from an appropriately accredited institution and three years of experience in policy and rate examinations, underwriting, claims adjusting work, or financial/marketing analysis; or an equivalent combination of training and experience.
Nice To Haves
- Proficiency in Excel.
- Experience in auditing, analysis, or other detail oriented work.
- Relevant industry designations (such as HIA, ALHC, MHP, RHU, MCM).
- Experience using NAIC information systems.
- Background in data mining and data analysis.
- Experience working with regulatory or compliance issues.
- Advanced understanding of health insurance operations, concepts, and applicable state statutes and regulations.
- Ability to interpret and apply laws and regulations, analyze complex information, and assess the impact of company policies and procedures.
- Strong verbal and written communication skills, with the ability to interact effectively with management, peers, and industry representatives.
Responsibilities
- Conduct Level 1 and Level 2 market analyses using the NAIC Market Analysis Review system.
- Review Market Conduct Annual Statement filings for Health and Other Health insurance products.
- Analyze trends in complaints, underwriting, claims handling, utilization management, grievances and appeals, provider access, and network adequacy.
- Assess financial and operational information to determine whether additional regulatory review or a market conduct examination is warranted.
- Monitor insurer compliance with North Carolina insurance laws and managed care regulations.
- Prepare clear, well‑supported market analysis reports and recommend regulatory actions when appropriate.
- Collaborate with Market Conduct Examiners to identify insurers that may require further examination.
- Evaluate health insurance data to identify patterns related to claim denials, rescissions, cancellations, prior authorizations, and consumer complaints.
- Maintain thorough, organized documentation to support regulatory findings, recommendations, and decisions.
Benefits
- 12 Annual paid Holidays
- North Carolina State Health Plan administered by AETNA
- Supplemental Benefits including: Flexible Spending Accounts, Accident Insurance, Cancer & Specified Disease, Critical Illness, Dental and Vision
- NC State Retirement (TSERS)
- WeSave Employee Discounts
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
