Bargaining Unit: Use for all Job Titles
Class Code: 032453
Education and Experience: Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to five years of full-time professional insurance claims processing (i.e. examiner, adjudicator, adjuster) or underwriter work.
Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to five years of full-time professional insurance sales management or insurance investigative work, of which two years must have been professional insurance investigative work similar in nature to that performed by Consumer Insurance Inv with the State of Tennessee.
Graduation from an accredited college or university with a bachelor’s degree and experience equivalent to three years 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 investigative work of considerable difficulty and supervisory work of average difficulty; and performs related work as required.
Distinguishing Features: An incumbent in this class has statewide responsibility for managing a unit of the Consumer Insurance Services Division in the Department of Commerce and Insurance, such as Fraud, Market Conduct, or Employee Insurance Benefit Control. An incumbent may also be responsible for supervising the Nashville office of the Policyholder Services Unit. Work involves supervising and conducting difficult aspects of interviewing company representatives. Work involves assigning and supervising field interviewing of complainants, policyholders, agents, brokers, and the general public to gather information, resolve complaints and disputes, and terminate illegal or unethical practices. This class differs from that of Insurance Investigator 2 in that an incumbent of the latter is responsible for the operation of a district office. This class differs from that of Insurance Investigation Director in that the incumbent of the latter directs the statewide program and supervises incumbents of this class.

Work Activities:

Developing Objectives and Strategies:
  1. Manages a statewide unit charged with the investigation of complaints, law violations, and resolution of problems of policyholders, the public, and insurance industry representatives.
  2. Generates SMART goals for assigned subordinates. 
Staffing Organizational Units:
  1. Makes recommendations on personnel actions such as employment, promotion, demotion, transfer, and retention. 
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. 
Coaching and Developing Others:
  1. Addresses deficiencies and achievements identified in the evaluation process through SMART goals and plans to mentor subordinates on the improvement of knowledge, skills, and abilities. 
Training and Teaching Others:
  1. Trains new hires in using the phone and computer system processes in order to manage case files. 
Thinking Creatively:
  1. Identifies database system improvements and submits ideas to system developer. 
Scheduling Work and Activities:
  1. Schedules out of office trips after a catastrophe for the purposes of providing advice to consumers with insurance related problems associated with the disaster. 
Organizing, Planning, and Prioritizing Work:
  1. Organizes and prioritizes case files according to established time metrics. 
Guiding, Directing, and Motivating Subordinates:
  1. Motivates subordinates by leveraging SMART goals and plans through the evaluation process. 
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. 
Provide Consultation and Advice to Others:
  1. Makes recommendations for changes in operations which affect the efficiency, and quality of agency operations and services. 
Interpreting the Meaning of Information for Others:
  1. Interprets company policy language, and definitions for consumers. 
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. 
Judging the Qualities of Things, Services, or People:
  1. Assists in the establishment and execution of methods used by investigators in the performance of their duties.
  2. Reviews the response letter and documentation provided for completeness and accuracy as it relates to the complaint.
  3. Reviews case reports submitted by other investigators on suspected violations and makes recommendations for resolutions.
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. 
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. 
Making Decisions and Solving Problems:
  1. Makes decisions related to applicability of a complaint as it relates to consumer insurance.
  2. Returns case file to the investigator for corrections through the review of files for completeness and coding errors. 
Developing and Building Teams:
  1. Models effective performance for co-workers and assigned subordinates to provide a role model, encourage success in others, and enhance trust. 
Coordinating the Work and Activities of Others:
  1. Assigns cases to assigned subordinates according to area of expertise. 
Communicating with Supervisors, Peers, or Subordinates:
  1. Submits case files for review to supervisor as requested.
  2. Submits complaint files and letter of recommendation to other sections for further action.
  3. Requests information from other sections regarding complaints.
  4. Provides consultation and advice to other investigators as needed. 
Documenting/Recording Information:
  1. Generates monthly reports regarding closed case files related to time metrics.
  2. Prepares reports of investigations as requested.
  3. Generates concise notes related to file in database. 
Processing Information:
  1. Enters NAIC reason and disposition codes into database.
  2. Generates concise notes related to case file in database.
  3. Verifies complainant and company information for each complaint resulting in acknowledgement and respondent letters. 
Operating Vehicles, Mechanized Devices, or Equipment:
  1. Travels to locations of disaster in order to assist consumers with needs. 
Communicating with Persons Outside Organization:
  1. Responds to insurance-related inquiries from the general public.
  2. Conducts interviews and investigations, to resolve difficult and sensitive disputes involving company representatives, complainants, policyholders, agents, brokers, and the general public. 
Performing Administrative Activities:
  1. Responds to emails, phone calls and other correspondence as required. 
Getting Information:
  1. Attains information from complaint form in order to review and interpret information and contact the complainant and respondent. 
Monitor Processes, Materials, or Surroundings:
  1. May conduct 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.

Competencies (KSA’s):

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

Tools and Equipment Used:

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


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