Bargaining Unit: Use for all Job Titles
Class Code: 032452
Education and Experience: Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to three years of full-time professional insurance sales management, claims processing (i.e. examiner, adjuster, adjudicator), or underwriter work.
Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to one year of full-time professional insurance investigative work similar in nature to that performed by Consumer Insurance Investigators with the State of Tennessee.
Substitution of Experience for Education: Qualifying full-time professional experience in insurance sales management claims processing, underwriting, or investigative work may be substituted for the required education on a year-for-year basis, to a maximum of four years.

Other Requirements:

Necessary Special Qualifications: None
Examination Method: Education and Experience, 100%, for Preferred Service positions.

Job Overview:

Summary: Under general supervision, is responsible for insurance investigation duties of average difficulty; and performs related work as required.
Distinguishing Features: This is the working-level class in the Consumer Insurance Investigator sub-series. An employee in this class may be assigned to a central office or to a district office. An incumbent performs a wide variety of sensitive and complex assignments in investigating complaints and enforcing state laws, primarily for a specific line of insurance. Work involves conducting interviews with company representatives, complainants, policyholders, agents, brokers, and the general public to gather information, resolve complaints and disputes, and terminate illegal or unethical practices. Work is performed with considerable independence and is reviewed by an administrative superior for effectiveness and sound judgment. This class differs from Consumer Insurance Investigator 2 in that an incumbent of the latter is responsible for the operation of a district office and investigates complaints in all lines of insurance.

Work Activities:

Resolving Conflicts and Negotiating with Others:
  1. Mediates complaints between the consumer and the insurance company based on information provided through documents and phone interviews with the goal of achieving a mutually acceptable solution. 
Communicating with Persons Outside Organization:
  1. Conducts interviews and investigations, to resolve difficult and sensitive disputes involving company representatives, complainants, policyholders, agents, brokers, and the general public.
  2. Responds to insurance-related inquiries from the general public. 
Evaluating Information to Determine Compliance with Standards:
  1. Evaluates response information in relation to state law, policy language as well as state and federal regulations. 
Interpreting the Meaning of Information for Others:
  1. Interprets company policy language, and definitions for consumers. 
Updating and Using Relevant Knowledge:
  1. Keeps knowledge up to date related to changes in laws and regulations.
  2. Researches information regarding laws and regulations based on consumer requests.
  3. Attends training related to changes in database systems. 
Monitor Processes, Materials, or Surroundings:
  1. Conducts investigations of complaints of policyholders and purchasers relating to insurance violations, unfair trade practices, or fraudulent activities by insurance agents or insurance companies, primarily for one line of insurance. 
Interacting With Computers:
  1. Utilizes enterprise resource planning software to enter time, leave, and overtime requests as well as travel authorizations.
  2. Utilizes database system to research companies in order to attain contact information. 
Judging the Qualities of Things, Services, or People:
  1. Reviews the response letter and documentation provided for completeness and accuracy as it relates to the complaint.
  2. Reviews case reports submitted by other investigators on suspected violations and makes recommendations for resolutions. 
Documenting/Recording Information:
  1. Prepares reports of investigations as requested.
  2. Generates concise notes related to file in database. 
Getting Information:
  1. Attains information from complaint form in order to review and interpret information and contact the complainant and respondent. 
Operating Vehicles, Mechanized Devices, or Equipment:
  1. Travels to locations of disaster in order to assist consumers with needs. 
Processing Information:
  1. Verifies complainant and company information for each complaint resulting in acknowledgement and respondent letters.
  2. Enters NAIC reason and disposition codes into database. 
Communicating with Supervisors, Peers, or Subordinates:
  1. Provides consultation and advice to other investigators as needed.
  2. Submits complaint files and letter of recommendation to other sections for further action.
  3. Submits case files for review to supervisor as requested.
  4. Requests information from other sections regarding complaints. 
Making Decisions and Solving Problems:
  1. Makes decisions related to applicability of a complaint as it relates to consumer insurance. 
Organizing, Planning, and Prioritizing Work:
  1. Organizes and prioritizes case files according to established time metrics.
Performing Administrative Activities:
  1. Responds to emails, phone calls and other correspondence as required. 
Provide Consultation and Advice to Others:
  1. Makes recommendations for changes in operations which affect the efficiency and quality of agency operations and services. 
Establishing and Maintaining Interpersonal Relationships:
  1. Establishes and maintains cohesive relationships with consumer insurance companies in order to attain information related to complaints.
  2. Establishes and maintains cohesive relationships with other insurance departments to share relevant information. 
Thinking Creatively:
  1. Identifies database system improvements and submits ideas to system developer. 
Training and Teaching Others:
  1. May train new hires in using the phone and computer system processes in order to manage case files.

Competencies (KSA’s):

  1. Written Communication
  2. Customer Focus
  3. Decision Quality
  4. Functional Technical Competency
  5. Conflict Management
  6. Composure
  7. Listening
  8. Business Acumen
  9. Time Management
  10. Interpersonal Savvy 
  1. Intermediate knowledge insurance industry
  2. Knowledge of basic computer applications
  3. Knowledge of customer and personal service principals
  4. Knowledge of laws and regulations related to insurance
  5. Knowledge of basic medical terminology 
  1. Active listening skills
  2. Speaking skills
  3. Reading comprehension skills
  4. Service orientation skills
  5. Time management skills
  6. Deductive reasoning skills
  1. Ability to extract information from complainants
  2. Oral comprehension ability
  3. Oral expression ability
  4. Written comprehension ability
  5. Written expression ability
  6. Ability to identify suspicious patterns and trends associated with insurance companies

Tools and Equipment Used:

  1. Computer
  2. Copier
  3. Printer
  4. Scanner
  5. Fax Machine
  6. Phone
  7. Calculator


Back to top button