09/21/2002 05390

INSURANCE INVESTIGATOR SUPERVISOR

DEFINITION: This is supervisory and advanced 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 plans, assigns and directs the investigation of complaints, hearing of disputes, enforcement of laws and resolution of problems of policyholders, the public and insurance industry representatives. Work involves supervising and conducting the most difficult aspects of interviewing company representatives, complainants, policyholders, agents, brokers and the general public to gather information, resolve complaints and disputes, and terminate illegal or unethical practices. Work also involves providing information on regulations, rights, privileges and means of expediting or settling claims, evaluating contractual provisions of insurance policies and referring suspected violations to appropriate staff for required action. Work is performed with considerable independence and is reviewed by an administrative superior for effectiveness and sound judgment through the review of reports and recommendations and staff conferences.

EXAMPLES OF WORK: Supervises and trains subordinates in the methods, techniques and procedures of insurance investigation, policyholder services and law enforcement.

Interprets rules, regulations, policies, standards, and objectives of the organization or program to subordinates.

Reviews case reports and refers suspected violations to appropriate staff for required action.

Conducts interviews, correspondence and investigations and hears and resolves the most difficult and sensitive disputes involving company representatives, complainants, policyholders, agents, brokers and the general public.

Conducts investigations to gather information on suspected violations or to provide service to policyholders or the general public.

Evaluates contractual provisions of insurance policies and provides information on regulations, rights, privileges and means of expediting or settling claims.

Represents the department at speaking engagements, public events and disaster recovery programs.

Employees in this class may participate in the performance of their subordinates' work consistent with operational or organizational requirements.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS AND ABILITIES: Knowledge of insurance terminology and the regulations pertaining to the contractual provisions of insurance policies and payment of claims.

Knowledge of the scope, content and purpose of regulations governing insurance companies.

Knowledge of insurance principles and practices.

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

Ability to investigate and assess consumer complaints regarding the handling of their grievances and/or inquires.

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

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

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

Ability to communicate effectively, orally and in writing.

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

MINIMUM EXPERIENCE AND TRAINING: One year of experience as an Insurance Investigator 2;

or

Eight years of progressively responsible 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

Any equivalent combination of experience and training.