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Insurance Investigator

  • 504638
  • PHOENIX
  • DEPT OF INSURANCE AND FINANCIAL INSTITUTIONS
  • Full-time
  • Closing at: Jan 28 2022 at 23:55 MST

DEPT OF INSURANCE AND FINANCIAL INSTITUTIONS

The Department of Insurance and Financial Institutions licenses, monitors, investigates, examines, and ensures the safety and soundness of, regulated entities. The Department also helps resolve consumer complaints against financial-services and insurance entities; takes action in response to violations of law; encourages competition, innovation, and economic development; collects taxes and assessments that support State government operations; combats auto theft and insurance fraud through public awareness campaigns, and funding for law enforcement and dedicated prosecutors.

Our mission is to help Arizonans receive the benefits and protections to which they are legally entitled by enforcing insurance and financial institution laws and by providing information and assistance and to combat vehicle theft.

Insurance Investigator

DEPT OF INSURANCE AND FINANCIAL INSTITUTIONS

Job Location:

Address:  

Posting Details:

Salary: $52,500 

Grade: 20

Closing Date: 

Job Summary:

Under general supervision of Investigations Manager, performs investigations regarding violations of the Arizona Revised Statutes,Title 20, and the Arizona Administrative Code, Title 20, Chapter 6, pertaining to the regulation of insurance. The investigative process is initiated with the receipt of a formal complaint or suspected violation. The employee then reviews, researches, analyzes, investigates, responds to and resolves a wide array of technical insurance-related questions and complaints (sometimes adversarial) involving all kinds of insurance companies, insurance professionals and intermediaries, as well as entities outside the agency's jurisdiction; assists consumers with insurance issues of varying degrees of difficulty by phone, in writing and in person. The process terminates with case closure due to an inability to substantiate the consumer's allegations, or alternatively, by a disciplinary action if the allegations are substantiated. Resolution can occur through a voluntary Consent Order executed by the Respondent or by recommendations for regulatory sanctions and penalties imposed by the Office of Administrative Hearings. May testify in administrative hearing or in court.

The Administrative Enforcement Unit investigates numerous types of complaints, including: unlicensed activity, alleged misconduct by insurance producers (primarily misappropriation of premium) and bail bond agents (failure to return collateral/fee disputes), and service companies (contract coverage disputes concerning vehicle and home warranties). Regulatory positions ensure compliance with applicable federal and state laws, rules and regulations.

Job Duties:

INVESTIGATE & GATHER EVIDENCE: Set up complaint file, including data and documents, in applicable databases; correspond with consumers to clarify complaints; determine whether the complaint is within the agency's jurisdiction; obtain, analyze and investigate records, complex contracts, insurance policies, claim files, financial data, and other information; request information from the subject of the complaint and other relevant sources; draft subpoenas for documents when necessary; research and properly apply federal and state insurance-related laws, rules, and regulations; query agency databases and Internet-based information; determine whether the subject of the complaint failed to comply with laws or insurance contract. Drive to various locations throughout Arizona to conduct field visits, to elicit additional info.

COMPLAINT RESOLUTION: Coordinate resolution of complaint on an informal basis by conducting meetings (Informal Settlement Conferences) with contending parties, addressing evidence gathered and steps to regain compliance with and/or resolution of the complaint. Negotiate and stipulate final agreements in writing (Consent Orders). Recommend to supervisor actions to be taken and resolutions of problems; coordinate with agency investigators on cases that appear to involve violations of Arizona insurance laws or rules; coordinate with market conduct analysts when cases appear to indicate a suspect has systemic problems or has general business practices that violate the law;

CASE MANAGEMENT: Maintain electronic case files in the Department's complaint database. Document telephone calls and in-person contacts, and save and upload any and all written documentation noted in the previous function. Update cases on a monthly, weekly, and often daily basis. When complaint is closed, record case disposition, and other pertinent data.

DOCUMENTATION: Prepare written correspondence including emails, formal requests for production of records, subpoenas to obtain account information from financial institutions and to conduct Examinations Under Oath, Summary Suspension Orders, Cease and Desist Orders, Disposition Reports, and Addenda. Prepare exhibits to accompany Disposition Reports being forwarded to the Arizona Attorney General Office.

Knowledge, Skills & Abilities (KSAs):

KNOWLEDGE
• Insurance-related laws and rules, regulations, case law and agency policies and procedures.
• Knowledge of Arizona Revised Statutes,Title 20, and Arizona Administrative Code, Title 20, Chapter 6, to determine the Department's jurisdiction upon receipt and assignment of a complaint.
• Insurance terms, concepts and generally accepted industry practices.
• How laws, rules, regulations, terms and concepts relate to the operations of various types of entities regulated by the agency.
• Knowledge of other administrative, civil and criminal statutes most commonly violated in
connection with unlawful insurance-related transactions to assist in determining the most
appropriate division or agency to handle the complaint.
• Insurance-related areas of law, such as the Employee Retirement Income Security Act (ERISA), Medicare laws and regulations. Acquired through on-the-job training or by independent study.
• Functions and duties of each division of the agency. Acquired through on-the-job training.
• Knowledge of insurance terminology, as well as insurance-related products and entities regulated by the Arizona Department of Insurance.
• Indicators (red flags) of law violations relating to different lines of insurance. Acquired through on-the-job training and by independent study.
• The investigation processes, methods and tools, and file documentation.
• Negotiation and mediation methods.
• Computer software such as Google Docs, Google Sheets, Microsoft Word (word processing), Microsoft Excel (spreadsheets), and Microsoft Access (database).
• Professional correspondence formats and grammar usage in written and verbal communications.
• Principles and practices of administration.
• Arizona Management System principles and practices.

SKILLS
• Skill to concurrently manage multiple responsibilities and tasks.
• Handling difficult communication scenarios.
• Using judgment to adapt to changing conversational dynamics.
• Applying laws, rules, and statutes to applicable scenarios.
• Applying reason and sound judgment to the review, decisions and recommendations on issues of significant complexity and difficulty.
• Planning, organizing, coordinating and establishing priorities for a varied workload, developing cogent investigative plans and conducting relevant research.

ABILITIES
• Reading and properly interpreting complex legal contracts, insurance policies, third-party administration agreements, and other technical and complex documents in relation to relevant laws, rules and policies.
• Interpreting the practices and procedures of insurance companies, producers, adjusters, bail bonds agents, surplus lines brokers and other licensed entities as governed by Arizona laws, rules and policies.
• Independently communicating clearly, effectively and diplomatically in writing, in person and on the telephone in routine and complex situations with consumers, attorneys, insurers, producers, licensed entities, agency staff and other state and federal employees, through the use of proper English, spelling and vocabulary.
• Writing, typing and proofreading documents.
• Working cooperatively to establish and maintain effective professional working relations with supervisor, agency staff, insurers, producers, other regulated entities, consumers and other parties seeking information or assistance from the agency.
• Ability to read and interpret legal contracts.
• Ability to research and analyze agency and public records/data applicable to the effective investigation of complaints and to apply the results of said research and analysis to the effective prosecution of the Respondent(s) at administrative hearings.
• Ability to conduct interviews.
• Ability to testify at administrative hearings.

Selective Preference(s):

Prior knowledge of the insurance industry. Job experience in conducting investigations as might be obtained from previous employment as an investigator or consumer service specialist from another regulatory agency; insurance claims adjuster; insurance company's SIU investigator; or law enforcement investigator/detective with experience in civil and/or criminal law.

Pre-Employment Requirements:

N/A

Benefits:

The State of Arizona provides an excellent comprehensive benefits package including:
− Affordable medical and dental insurance plans
− Paid vacation and sick time
− 10 paid holidays per year
− Wellness program and plans
− Life insurance
− Short/long-term disability insurance
− Defined retirement plan
− Credit union membership
− Transit subsidy

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

To help you build a financially secure future, the State makes monthly contributions to finance your retirement benefit. The State will make a contribution to the ASRS in an amount equal to your contribution. In other words, you and the State will each pay 50% of the total cost of the benefit. New State employees have a 27 week wait period for contributions to begin.

Contact Us:

Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 364-0108. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. DIFI is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.

ARIZONA MANAGEMENT SYSTEM (AMS)

All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress.  Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.  
State employees are highly engaged, collaborative and embrace a culture of public service.

The State of Arizona is an Equal Employment Opportunity Employer.