11/01/1987 04190

DIRECTOR, ACCIDENT AND HEALTH RATE AND POLICY FORM REVIEW

DEFINITION: This is responsible managerial work in directing the review and analysis of accident and health insurance rates, rating plans, policies and related forms in accordance with insurance laws and regulations.

The employee in this class plans, develops, directs and coordinates the programs to review, analyze, approve or disapprove insurance companies in accordance with applicable laws and regulations. Work involves directing the actuarial review and analysis of rates, rating plans, rating procedures and schedules for commercial individual accident and health insurance plans, non-profit medical and surgical, and health maintenance organization insurance policies and related forms, and preferred provider organization plans, in accordance with insurance rate and policy form filings. The employee drafts, or directs drafting of, regulations and guidelines interpreting laws relating to accident and health insurance. The employee is responsible formulating and recommending policies to the Deputy Insurance Commissioner for Rate and Policy Form Regulation. Supervision is exercised over a professional and technical staff engaged in actuarial and policy examination work. Work is performed with independence under the general direction of the Deputy Insurance Commissioner who supervises work through conferences, reports and an evaluation of program effectiveness.

EXAMPLES OF WORK: Plans, develops, directs and coordinates the program to review, analyze and approve or disapprove insurance rates, rating plans, rating procedures and schedules for commercial individual accident and health insurance plans, non-profit medical and surgical plans, and health maintenance organization.

Plans, develops, directs and coordinates the program to review, analyze and approve or disapprove commercial individual accident and health, non-profit medical and surgical, and health maintenance organization insurance policies and related forms, and preferred provider organization plans, in accordance with insurance laws and regulations.

Directs the collection and analysis of statistical data supporting decisions relating to accident and health insurance policy forms and rate filings.

Directs the review of advertising material related to accident and health insurance laws and regulations.

Directs the preparation of information and testimony to be used in administrative hearings and court proceedings.

Drafts, or directs drafting of, regulations and guidelines interpreting laws relating to accident and health insurance, and assist in drafting legislation in the area of accident and health insurance.

Corresponds and confers with accident and health insurance officials regarding company operation, marketing procedures, and rate and policy form filings.

Formulates and recommends policies regarding the life rate and policy form review program to the Deputy Insurance Commissioner for Rate and Policy Form Regulation.

Plans and organizes work, assigns work, determines work priorities, sets goal and reviews and evaluates employee work performance.

Assesses training needs of staff and develops plans to meet those needs.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of accident and health insurance principles and practices, including underwriting and marketing and claims practices.

Knowledge of actuarial principles, rate making formulae and statistical analysis of insurance data as they apply to accident and health insurance.

Knowledge of provisions of accident and health insurance policies and related forms.

Knowledge of state laws and Department regulations relating to accident and health insurance.

Knowledge of the principles and practices of administration and supervision.

Ability to evaluate insurance policy and rate data as they relate to accident and health insurance in order to make sound decisions and recommendations.

Ability to analyze accident and health insurance policy form and rate filings.

Ability to plan and supervise the work of others.

Ability to establish the maintain effective working relationships with associates, insurance company officials, and trade association representatives.

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

MINIMUM EXPERIENCE AND TRAINING: Two years of experience as a Life and Health Insurance Policy Examiner Supervisor in the Bureau of Accident and Health Rate and Policy Form Review.

or

Two years of experience as an Accident and Health Insurance Actuary Supervisor;

or

Eight years of progressively responsible experience in accident and health insurance rate preparation, analysis or research, underwriting or sales, or in drafting or reviewing and examining accident and health insurance policies and forms, or in a closely related area, including two years in an administrative or supervisory capacity, and a Bachelor's degree;

or

Designation as a Fellow of the Society of Actuaries;

or

Designation as an Associate of the Society of Actuaries and six years of professional insurance work;

or

Any equivalent combination experience and training.