11/01/1987 04110

Chief, Insurance Field Investigations and Enforcement

DEFINITION: This is administrative and advanced public contact work in field insurance investigation and the enforcement of state laws pertaining to companies, agents and brokers.

The employee in this class administers and coordinates a statewide program to enforce state laws pertaining to insurance companies, agents and brokers through the conduct of onsite investigations. An important aspect of the work is directing the conduct of highly sensitive special investigations involving fraudulent, illegal or unethical insurance practices, negotiating consent orders with individuals and attorneys representing individuals who are alleged to have violated the insurance laws, and proposing the language used and penalties imposed in final orders of the department. Liaison is maintained with all divisions of the Insurance Department who refer potential violations for investigation and enforcement. The employee also serves as liaison with state and federal investigators and prosecutors for activities under their jurisdiction which involve insurance. The employee recommends policy to the Insurance Commissioner and the Deputy Insurance Commissioner in all areas of enforcement and field investigation activities. The employee also makes decisions regarding the subject of investigations, the assignment of appropriate resources, and the manner in which investigations are to be accomplished. Work includes supervising insurance investigators in the conduct of field investigations of credit life, accident and health practices, automobile dealers, finance companies, banks and related organizations selling insurance and claims practices of licensed companies. Supervision is exercised over a staff of insurance investigators located throughout the state. Work is performed with a high degree of independence and is reviewed by an administrative superior for effectiveness, soundness of judgment and adherence to Department policy.

EXAMPLES OF WORK: Directs, coordinates and supervises a statewide program to enforce state laws, acts and regulations pertaining to insurance companies, agents and brokers through the conduct of onsite investigations.

Directs or conducts highly sensitive or special investigations involving fraudulent, illegal or unethical insurance practices by companies, agents or brokers at the request of the Insurance Commissioner.

Negotiates consent orders with individuals and attorneys representing individuals who are alleged to have violated the insurance laws.

Recommends language to be used in final consent orders.

Recommends policy to the Insurance Commissioner and the Deputy Insurance Commissioner in all areas of enforcement and field investigation activities.

Determines the subject of investigations, the assignment of appropriate resources, and the manner in which investigations are to be accomplished.

Reviews investigation and case reports and recommends corrective action to the appropriate office.

Plans and organizes work, assigns work, determines work priority, sets goals, reviews work performance and evaluates employee work performance.

Directs, coordinates and supervises the conduct of statewide field investigations of credit life and credit accident and health practices, automobile dealers, finance companies and banks which sell insurance and claims practices of licensed companies.

Directs, coordinates and supervises an inspection program of agents licensed to conduct business under the Surplus Lines Act to assure full compliance with the provisions of the Act.

Testifies at informal administrative hearings to present evidence gathered as a result of an investigation where an alleged violation of the law has occurred.

Oversees the placement of insurance negotiated by agents who have authority to conduct business under the Surplus Lines Act.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of insurance principles and practices.

Knowledge of insurance laws, rules and regulations.

Knowledge of insurance claims procedures.

Knowledge of evidence-gathering procedures, the principles and practices of law enforcement and the principles of field investigations.

Knowledge of principles and practices of administration and supervision.

Ability to review and analyze investigations and case reports and to recommend appropriate action.

Ability to conduct highly sensitive or special investigations involving illegal or unethical insurance practices.

Ability to plan, assign, direct and supervise the work of subordinates.

Ability to evaluate and interpret insurance regulations and contractual provisions of insurance policies.

Ability to prepare reports.

Ability to establish and maintain effective working relationships with representatives of the insurance industry and general public.

Ability to clearly express ideas orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: Four years of insurance investigation experience with a public agency.

or

Four years of progressively responsible experience in insurance underwriting, claims, sales, or investigation including or supplemented by two years of public contact work in field investigation; and a bachelor's degree.

or

Four years of progressively responsible experience in criminal investigation work; and a bachelor's degree.

or

Any equivalent combination of experience and training.