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INSURANCE INVESTIGATOR

The Insurance Investigator is responsible for resolving complaints filed by the public regarding insurance. This position is governed by state and federal laws and

Class Code:

X123C

Job Grade:

GS05

Special Job Requirements:

FEDERAL GRANT POSITION: This position assist consumers of Arkansas with the new HealthCare Reform laws and provisions, handle inquiries and complaints. It will have the responsibility, authority and capability to collect, analyze, and report objective, a

Typical Functions:

Reviews written complaints to determine the nature of the complaint and develops a course of action for resolution. Conducts investigations to determine if employers are required to have workers’ compensation insurance coverage. Interviews employees, employers, and their representatives to obtain recorded statements. Conducts research utilizing the Internet, Westlaw, and court records; performs coverage searches utilizing the National Council on Compensation Insurance. Conducts investigations in response to complaints from the general public regarding insurance companies, agents or adjuster issues; consults with consumers via telephone, written communication or in person visits. Conducts undercover and on-sight impromptu investigations of suspected fraudulent activity. Gathers information, compiles evidence, and provides testimony at legal proceedings. Writes inquiries and composes follow-up correspondence to insurance companies and to complainants. Provides technical and general information to the general public and employers. Performs other duties as assigned.

Knowledge, Abilities, and Skills:

Knowledge of state and federal laws and regulations governing the insurance industry. Knowledge of general business practices and procedures. Knowledge of insurance claims processing procedures. Ability to review complaints and initiate action for resolution. Ability to identify sources for required information in order to obtain needed information. Ability to discuss issues with others, mediate problems or conflicts, and work to reach a fair agreement. Ability to prepare and present oral and written information and reports.

Minimum Qualifications:

The formal education equivalent of a high school diploma; plus two years of college coursework in business procedures and operations; plus two years of work experience in insurance, claims processing, or a related field. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

Required Certificates:

None

Exempt:

N
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