08/27/2002 05380

INSURANCE INVESTIGATOR 2

DEFINITION: This is advanced investigative and public contact work in the handling of insurance complaints, including claims issues and the enforcement of state laws pertaining to insurance agents, brokers, and companies.

An employee in this class receives and investigates complex insurance complaints and claims in one line of insurance or serves in a multi-line capacity by gathering and analyzing the facts from the complainant and the insurance company or insurance representative and recommending appropriate disposition in accordance with applicable laws and regulations. Responsibilities include investigating life, health, or property and casualty complaints and answering questions from policyholders and the general public regarding the contractual provisions of insurance policies and the interpretations and application of insurance laws and regulations. Work also involves the investigation and analysis of insurance complaints, including monetary issues such as payment amounts, denial of claims, and refusal to pay for services. Work is performed independently and is reviewed by an administrative superior for effectiveness and sound judgment.

EXAMPLES OF WORK: Investigates multi-line complaints or serves as the office expert in a particular line of insurance.

Investigates insurance complaints by gathering all relevant information from the complainant and determining how complaint should be pursued.

Answers questions regarding insurance laws, regulations and acts, and contractual provision of insurance policies.

Conducts investigations to assure compliance with various insurance laws, regulations and acts by reviewing the insurance company’s files in reference to the specific investigation.

Prepares a standard report on the investigations, if a violation has occurred and a referral to the Bureau of Enforcement is necessary.

Recommends appropriate civil or criminal action to the supervisor if a violation of the law has occurred.

Contacts insurance brokers to explain the provisions of the surplus lines law.

Distributes brochures and responds to questions at consumer events. Provides on-site consumer insurance assistance to disaster victims.

Performs other related duties as required.

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

Knowledge of insurance laws, rules, and regulations.

Ability to gather information through interviews and the review of records, files, correspondence and documents.

Ability to objectively evaluate information received and to make sound recommendations.

Ability to maintain effective working relationships with complainants, insurance industry representatives, and the general public.

Ability to communicate effectively, orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: One year as an Insurance Investigator 1;

                                                                                                                                                                                                   or

Seven years of experience as an insurance investigator, underwriter, agent, broker or claims adjuster. College level training may be substituted on a year-for-year basis for four years of the required experience;

                                                                                                                                                                                                   or

An equivalent combination of experience and training.