This class series uses two levels in the Public Safety occupational group, Investigative Series occupational series and describes examining and investigating insurance company marketing practices in the areas of sales and advertising, underwriting, rating and claims which normally are not the subject of specific complaints. This work is distinguished from the Investigator positions within the Office of Insurance Commissioner by having the responsibility of discerning and investigating improper and unlawful insurance practices ordinarily not disclosed by complaints, such as improper rate setting, misleading advertising practices, unfair claim settlement practices, etc. Except for very complex cases, an incumbent is not an investigator of complaints. Work involves detecting and developing trends and patterns of violations and investigating these rather than performing the reactive role of complaint investigator.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Detects and develops trends and patterns of improper and illegal insurance practices using a variety of sources, such as financial documents, a poor history of a company's consumer relations and information obtained from trade associations, co-workers or from other states.
Investigates cases, obtains evidence and writes a report of the alleged abuses for the Commissioner's determination of appropriate action.
Acts as representative of the Department in contested cases.
Negotiates Consent Orders or other compromise arrangements regarding non-compliance by insurers.
Monitors national market conduct trends and patterns by maintaining close contact with other states and the National Association of Insurance Commissioners.
Investigates specific complaints of a complex nature.
Supervises the collection of and analyzes data which indicates changes in a company's premium patterns, lines of coverage, commissions paid, unpaid claim balances and loss adjustment expenses and identifies companies with a poor record of consumer relations.
Conducts public meetings and public hearings.
Levels of Work
Market Conduct Examiner
This is the full performance level of examining and investigating insurance company marketing practices work.
Reports to a technical supervisor.
Performs the full range of Essential Functions.
Contacts include agents, brokers, adjusters and insurance company executives in order to protect the public from unethical and illegal practices.
Market Conduct Examiner and Licensing Supervisor
This is the supervisory level of examining and investigating insurance company marketing practices work and licensing producers, adjusters, appraisers, and other licensees work.
Reports to a technical supervisor.
Supervision is exercised over at least two or more merit full time positions per the Merit Rules. The elements of supervision include planning, assigning, reviewing, evaluating, coaching, training, recommending hire/fire and discipline.
Conducts the most complex investigations, agency examinations, and licensing reviews.
Develops, recommends, and implements policies and procedures to ensure efficient and consistent application of insurance examinations, investigations, and licensing.
Participates in drafting new and revised legislation and regulations for consumer protection and market conduct.
Recommends and implements enforcement proceedings against licensees for violation of licensure standards and unfair trade practices.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of insurance laws, regulations, industry practices and procedures.
Knowledge of administrative law hearing procedures.
Knowledge of generally accepted accounting principles as they pertain to insurance activities.
Knowledge of the principles and techniques of investigation and evidence gathering which is acceptable by law.
Knowledge of the standards recommended by the National Association of Insurance Commissioners.
Knowledge of the goals, objectives and procedures of the Insurance Department.
Knowledge of the personnel and practices of the Delaware insurance community.
Ability to discern and investigate possible misconduct in the insurance industry from sources other than complaints.
Ability to conceive, design, organize, and implement unique programs to discover improper conduct of insurance personnel.
Ability to obtain acceptable evidence for a legal hearing.
Ability to negotiate Consent Orders.
Ability to conduct public hearings and public meetings.
Ability to interpret, apply and explain laws, regulations, practices and procedures of insurance activities.
Ability to analyze financial documents such as Annual Reports and Profit Loss Statements.
Ability to write clear, concise, informative reports.
Ability to establish and maintain effective working relationships with co-workers and the insurance community.
In addition to the above Knowledge, Skills and Abilities, the Market Conduct Examiner and Licensing Supervisor requires:
Knowledge of supervisory principles and practices.
Knowledge of developing and implementing policies and procedures.
Skill in conducting investigations, agency examinations, and licensing reviews.
Skill in detecting and developing trends and patterns of improper and illegal insurance practices.
Skill in interpreting, applying, and explaining appropriate laws, rules, regulations, standards, practices, and procedures.
JOB REQUIREMENTS for Market Conduct Examiner Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Six months experience in accounting using Generally Accepted Accounting Principles (GAAP).
Six months experience in conducting investigations which includes conducting interviews to obtain confidential information, gathering evidence and documenting findings.
Six months experience in compiling, analyzing and interpreting financial data to ensure effective and efficient accounting of funds or to make projections for financial planning.
Six months experience in civil, criminal or administrative proceedings.
Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
Six months experience in narrative report writing.