09/01/1986 03470

LIFE AND HEALTH INSURANCE POLICY EXAMINER 1

DEFINITION: This is technical work in reviewing and examining life, annuity, fraternal, non-profit, health maintenance organization, and accident and health insurance policies and related forms to determine conformity to laws and Department regulations.

An employee in this class is responsible for reviewing, analyzing, and approving or disapproving policies, certificates, endorsements, riders, applications, and subscription agreements for the above types of insurance. Employees assist the actuarial staff in review of rates to ensure compliance with laws and Department regulations. Employees review and analyze advertising material to ensure compliance with laws and regulations. Work includes contacting insurance company representatives to secure information in order to support or clarify policy or form filings. Work is performed with some independence, and is reviewed as required through conferences with a technical superior for acceptability and adherence to established standards.

EXAMPLES OF WORK: Reviews, analyzes, and approves or disapproves policies, certificates, endorsements, riders, applications for health maintenance organization, and accident and health insurance companies.

Assists actuarial staff in reviewing life, accident and health, annuity, fraternal, and non-profit and health maintenance organization rates to insure compliance with laws and Department regulations.

Reviews life, health and related types of insurance forms to assure that they are well constructed and written in a manner easily understood by the policyholder.

Reviews and analyzes advertising material to insure compliance with laws and Department regulations.

Advises insurance company representatives orally and in writing of the results of reviews and analyses of policies and related forms.

Answers inquiries from policyholders and the general public regarding insurance laws, regulations, policy provisions and statutes.

Attends meetings with other Divisions of the Insurance Department relating to approval of policies and related forms.

Provides technical assistance to bureau programs as required.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of life and health insurance principles and practices, including principles and practices of underwriting and the socio-economic influences of insurance.

Knowledge of the provisions of life and health insurance policies and related forms.

Knowledge of the rate-making principles and practices applicable to life and health insurance.

Ability to analyze insurance policies and related forms.

Ability to interpret and comprehend insurance-related data.

Ability to express ideas clearly and concisely, orally and in writing.

Ability to establish and maintain effective working relationships with associates and insurance companies.

MINIMUM EXPERIENCE AND TRAINING: One year as a Financial Management Trainee, or an Administration and Management Trainee or in any other Trainee class which is Management related that involved insurance policy examination work, including at least six months in the life and health insurance area;

or

Three years of experience in life and/or accident and health insurance sales or underwriting, or in drafting or reviewing and examining life and/or accident and health insurance policies and forms, or in a closely-related area; and satisfactory completion of two years of business school or college;

or

Any equivalent combination of experience and training which included at least one year of experience in life and/or accident and health insurance sales or underwriting, or in drafting or reviewing and examining life and/or accident and health insurance policies and forms;

or

Designation as a Chartered Life Underwriter.