08/02/2002 05370

INSURANCE INVESTIGATOR 1

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

An employee in this class receives and investigates routine insurance complaints in one line of insurance 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. Work includes answering questions from policyholders and the general public regarding the contractual provisions of insurance policies and the interpretation and application of insurance laws and regulations. Assignments involve the less complex forms of insurance complaints, including policy clarification issues such as cancellation or non-renewal of policies. Responsibilities include investigating life, health, and/or property and casualty complaints. Work may also involve contacting insurance brokers to explain the provisions of the surplus lines law. Work is distinguished from the higher level by the
structured nature of the work assignments. Work is performed under the direction of an administrative superior who discusses investigations in progress as needed and routinely reviews reports of completed investigations.

EXAMPLES OF WORK: Investigates insurance complaints in a particular line of insurance by gathering all relevant information from the complainant and recommending an appropriate resolution.

Contacts insurance representatives to gather facts related to complaint investigations.

Analyzes the facts in accordance with applicable laws and regulations and recommends proper disposition of the complaint

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

Prepares standard reports 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.

Distributes brochures and responds to questions at consumer events.

Provides on-site consumer insurance assistance to disaster victims.

Performs related work 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 Administration and Management Trainee performing insurance work;

or

Five 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 three years of the required experience;

or

Completion of the agency approved training program;

or

An equivalent combination of experience and training.