09/01/1986 03480

LIFE AND HEALTH INSURANCE POLICY EXAMINER 2

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

An employee in this class is responsible for reviewing, analyzing, and approving or disapproving policies, certificates, loan instruments, endorsements, riders, applications, subscription agreements and health provider contracts for the above types of insurance. Work involves the application of independent judgment in reviewing, analyzing, and approving or disapproving complex or unusual policies and related forms, and in assisting lower-level examiners. Employees assist the actuarial staff in reviewing rates to ensure compliance with laws and Department regulations. Employees review and analyze advertising material to ensure compliance with laws and Department regulations. Work includes contacting insurance company representatives to secure supporting or clarifying information, for policy or form filings. Work is performed independently 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, health provider contracts and subscription agreements of life, annuity, fraternal, separate account, accident and health, credit, and non-profit insurance companies.

Assists actuarial staff in reviewing life, accident and health, annuity, credit, separate account, fraternal, non-profit, and health maintenance organization rates to ensure 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 ensure compliance with the 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 questions from members of the legislature, policyholders, the general public, attorneys, financial institutions, and others regarding life and health insurance laws and regulations and provisions of life and health insurance contracts.

Confers with other state regulatory bodies and with trade associations about life and health insurance matters.

Assists lower-level examiners with problems relating to the review, analysis, and approval or disapproval of policies and related forms.

Assists in drafting regulations and guidelines interpreting life and health insurance laws.

Attends meetings with other Divisions of the Insurance Department relating to approval or disapproval 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 State Laws and Department regulations relating to life and health insurance.

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

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 with insurance company and trade association representatives.

MINIMUM EXPERIENCE AND TRAINING: One year of experience as a Life and Health Insurance Policy Examiner 1;

or

Four 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 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 two 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

Designation as a Chartered Life Underwriter.