Market Conduct Examiner

State of Montana • Helena, MT

3d • Onsite

About The Position

CSI has an opportunity for a full-time Market Conduct Examiner in the Market Conduct Bureau in Helena, Montana. 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.

Requirements

• 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.
• 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.
• Must be able to successfully complete Accredited Insurance Examiner (AIE) and Certified Insurance Examiner (CIE) certifications within the timeframe specified upon hire.
• Successful completion of background and fingerprint checks.
• Possession of a valid driver's license.

Nice To Haves

• Professional insurance designations such as CLU or CPCU.
• 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.

Responsibilities

• 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.

Benefits

• State of Montana benefits, including retirement, health insurance options, paid leave, and predictable hours
• Student loan forgiveness under the Public Service Loan Forgiveness may be possible.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level