About this Job Division: Office of Health, Life & Annuity/ Policy Compliance. The Louisiana Department of Insurance is seeking an Insurance Specialist 4 to join the Office of Health, Life & Annuity/ Policy Compliance Division. This division plays an important role in overseeing utilization management activities, administering the state’s external review process, and supporting regulatory compliance programs affecting health insurers and pharmacy benefit managers. In this position, you’ll review complex regulatory matters, research insurance laws, conduct investigations, and provide guidance to support leadership in regulatory decision-making. If you enjoy analytical work, interpreting regulations, and contributing to the fair and effective oversight of Louisiana’s insurance market, we encourage you to apply! 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; ORA 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 and Other Information Job Duties:As an Insurance Specialist 4 in the Office of Health, Life & Annuity/ Policy Compliance Division, you will/may:Serve as a lead worker overseeing utilization management processes and administering the state’s external review program, including monitoring assignments of external review cases and determining eligibility for external review requests submitted to the Department. Review utilization management policies and procedures for compliance with applicable federal and state laws and regulations and coordinate utilization management regulatory and audit activities. Conduct specialized policy research involving the analysis and interpretation of federal and state laws, rules, regulations, and policy literature related to health insurance, life insurance, annuities, and actuarial practices. Monitor state and federal legislative and regulatory developments affecting the health insurance, life insurance, and annuity industries and evaluate potential impacts on departmental programs and regulatory oversight. Conduct high-level investigations into incomplete or ineligible requests for external review within the Department’s remedial authority and communicate deficiencies and corrective options to insureds and their designated representatives. Review legislative proposals and enacted legislation affecting the Department and the regulated insurance industry and make substantive and procedural recommendations regarding their potential impact on departmental operations and regulatory authority. Assist with monitoring, reviewing, and supporting the implementation of compliance programs related to pharmacy benefit managers (PBMs) and health insurers, including PBM Drug Utilization Review, pharmacy reimbursement appeal processes, prompt pay compliance, material modifications of PBM procedures, and medical discount plan oversight. Respond to inquiries and assist with regulatory oversight related to PBM transparency requirements, prior authorization programs, utilization review, dental loss ratio reporting, ambulance rate requirements, and wholesale acquisition cost reporting. Support the development and implementation of new regulatory programs related to PBM oversight and transparency, including functions established under Act 474 (2025), such as PBM compensation program regulation, rebate and spread pricing review, administrative appeals, and annual certification requirements. Perform high-level reviews of complex health, life, and annuity form filings, including independently monitoring legal and regulatory changes that may affect form requirements and compliance determinations. Meet with other LDI divisions, insurance company representatives, government officials, attorneys, and members of the public to discuss regulatory issues related to health insurance, life insurance, and annuity products. Assist with special projects, reports, and other related duties as assigned by the Deputy Commissioner and the Insurance Administrator for the Office of Health, Life and Annuity. Position-Specific Details:Appointment Type: Probational or Job Appointment. Career Progression: This position will be filled as an Insurance Specialist 4. Location: Office of Health, Life & Annuity/ Policy Compliance Division. Compensation: The salary offered will be determined based on qualifications and experience. How To Apply:NO CIVIL SERVICE exam is required to be considered for this vacancy. To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page. - Information to support your eligibility for the position must be included in the application (i.e., relevant, detailed experience/education). Resumes will not be accepted in lieu of completed education and experience sections. Applications may be rejected if incomplete. 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 Phillip. Donagriche@ldi.la.gov. Louisiana is a State As a Model Employer (SAME) that supports the recruitment, hiring, and retention of individuals with disabilities.