Insurance Specialist 4

State of Louisiana; Baton Rouge (LA); On-site; USD 60,000 - 90,000; Full time

Job summary

The Louisiana Department of Insurance seeks an Insurance Specialist 4 to join the Office of Health, Life & Annuity/Pharmacy Benefit Management Enforcement Division. This role conducts complex investigations and regulatory reviews of PBMs, analyzes technical and financial information, and supports enforcement actions to ensure compliance.

The position emphasizes ongoing knowledge of state and federal laws, strong analytical skills, and collaboration with company officials and stakeholders to

Qualifications

• Six years of experience in insurance, administrative services, investigations, or law enforcement.
• Six years of full‑time work experience in any field plus three years of experience in insurance, administrative services, investigations, or law enforcement.
• A bachelor's degree plus three years of experience in insurance, administrative services, investigations, or law enforcement.

Responsibilities

• Conduct complex investigations and compliance reviews of PBMs to ensure compliance with state and federal laws and regulations.
• Review and analyze technical, financial, and operational documentation, reports, and other information submitted by PBMs and related entities.
• Meet with company officials and other stakeholders to gather information and evaluate PBM practices.
• Analyze investigative findings and market information to identify potential violations and compliance concerns.
• Prepare investigative reports and supporting documentation for regulatory and enforcement actions.
• Draft correspondence, notices, and other documents related to enforcement activities, and participate in hearings and related proceedings.

Skills

Investigations

Regulatory compliance

Stakeholder management

Analytical thinking

Communication

Education

Bachelor's degree

Advanced degree

Tools

Regulatory reporting software

Job description

About This Job

The mission of the Department of Insurance is to enforce the insurance laws and regulations of the state impartially, honestly and expeditiously.

The Louisiana Department of Insurance is seeking an Insurance Specialist 4 to join the Office of Health, Life & Annuity/Pharmacy Benefit Management (PBM) Enforcement Division. This position performs complex investigations and compliance reviews of pharmacy benefit managers (PBMs), analyzes technical and financial information, and supports regulatory enforcement activities to ensure compliance with applicable state and federal laws and regulations.

Core Competencies

The ideal candidate possesses the following competencies:

• Developing Plans: The ability to create structured strategies and plans that support the achievement of defined goals and objectives.
• Making Accurate Judgments: The ability to assess options, weigh risks, and make sound decisions using available information and logical reasoning.
• Managing Stakeholders: The ability to identify key stakeholders, manage relationships, and align interests to move work forward.

Minimum Qualifications

Six years of experience in insurance, administrative services, investigations, or law enforcement; OR

Six years of full‑time work experience in any field plus three years of experience in insurance, administrative services, investigations, or law enforcement; OR

A bachelor's degree plus three years of experience in insurance, administrative services, investigations, or law enforcement; OR

An advanced degree plus two years of experience in insurance, administrative services, investigations, or law enforcement.

Experience Substitution

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full‑time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Job Specification

The official job specifications for this role, as defined by the State Civil Service, can be found here.

Job Duties

Job Duties and Other Information

As an Insurance Specialist 4 in the Office of Health, Life & Annuity/Pharmacy Benefit Management (PBM) Enforcement Division, you will/may:

• Conduct complex investigations and compliance reviews of pharmacy benefit managers (PBMs) to ensure compliance with state and federal laws and regulations.
• Review and analyze technical, financial, and operational documentation, reports, and other information submitted by PBMs and related entities.
• Meet with company officials and other stakeholders to gather information and evaluate pharmacy benefit management practices.
• Analyze investigative findings and market information to identify potential violations and compliance concerns.
• Prepare investigative reports and supporting documentation for regulatory and enforcement actions.
• Draft correspondence, notices, and other documents related to enforcement activities, and participate in hearings and related proceedings.
• Maintain current knowledge of state and federal laws, regulations, and regulatory developments affecting pharmacy benefit management.
• Perform other duties related to pharmacy benefit management oversight as assigned.

Position‑Specific Details

Division/Location: Office of Health, Life & Annuity/Pharmacy Benefit Management (PBM) Enforcement Division

Appointment Type: Promotional or Probational

Career Progression: This position will be filled as an Insurance Specialist 4

Compensation: The salary will be determined based on qualifications and experience within the established pay range.

NO CIVIL SERVICE exam is required to be considered for this vacancy.

Contact Information

For further information about this vacancy, contact:

Dr. Phillip Donagriche

Human Resources Division

Louisiana Department of Insurance

P.O. Box 94214

Baton Rouge, LA 70804

[e-mail]

Louisiana is a State As a Model Employer (SAME) that supports the recruitment, hiring, and retention of individuals with disabilities.

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to make a difference through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career.

As a State Employee, You Will Earn Competitive Pay, Choose From a Variety Of Benefits, And Have Access To a Great Professional Development Program:

Insurance Coverage More information can be found at https://info.groupbenefits.org/

Parental Leave – Up to six weeks paid parental leave

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