Insurance Compliance, Department of Insurance Consolidated Series

California State Personnel Board Specification

Series established November 14, 2000

Scope

This consolidated series specification describes five Insurance Compliance, Department of Insurance, classifications used for positions with professional or supervisory responsibilities for the consumer service programs at the Department of Insurance.

Definition of Series

The Insurance Compliance, Department of Insurance, series describes classes concerned with regulatory work to ensure compliance with the California Insurance Code and other insurance laws as related to insurance rating, underwriting, and claims issues. This series provides for five levels of technical, analytical, professional, and supervisory skills required to ensure the effective and efficient regulatory operation of the Department of Insurance. Functional areas include, but are not limited to, claims, underwriting, rating, and communication. Incumbents perform technical and analytical work to identify violations of insurance laws by insurance providers regarding rating, underwriting, and claims practices and initiate corrective or enforcement actions; provide direct technical information to resolve informal/formal consumer complaints; mediate complaints between consumers, their agents, and insurers with complaints concerning insurance rating, underwriting, or claims issues; and conduct field market examinations of the application and interpretation of policy forms, transactions, and claims practices to determine if insurers are fulfilling their obligations to adhere to State laws regarding unfair discrimination and/or fair claims practices.

Entry Level

Entry into this series is typically from comparable professional levels outside State service, from college recruitment sources, or a related State classification of a lower level.

Factors Affecting Position Allocation

The level, variety, and complexity of work; independence of action; level and impact of decision making; degree of supervision exercised and received; the degree of independence and judgment required in making determinations and the consequence of error; type and frequency of contact with others; and supervisory and management responsibilities.

Definition of Levels

Insurance Compliance Officer, Department of Insurance

This is the entry and first working level of the series. Under supervision of a Supervising Insurance Compliance Officer, Department of Insurance, incumbents investigate and mediate those inquiries or cases where the issue or issues in dispute are clearly discernible and involve limited contact or investigation with the insurer, agent, or other entity in order to resolve the subject(s) at issue; take first-level enforcement actions; respond to consumer inquiries and complaints regarding all lines of insurance and provide the specific information requested and/or identify insurance practices that are noncompliant with current laws and suggest means of resolution, as appropriate, regarding insurance coverages, rates and rating plans, and claims handling practices where additional investigation through contact with the insurers or other parties is not necessary; either serve as a team member in a nonlead capacity on a market conduct examination examining files for noncompliant activity and conducting other standard elements of the examination process or work alone to conduct examinations of those insurers, third-party administrators, or managing general agents typically with limited premium levels or claims activity or with limited lines of business written; direct the insurance organization under examination to resolve issues, complaints, or violations of insurance laws; identify inquiries which warrant referral or investigation and assist the consumer in filing a complaint; represent the Department at meetings with a consumer, agent, or insurer; input claimant information directly into the Department's online database system; and do other related work.

Positions are permanently allocated to this class when the major portion of tasks performed do not include the more complex, varied, and responsible insurance regulatory activity found at the full journey level.

Associate Insurance Compliance Officer, Department of Insurance

This is the full-journey level of the series. Under direction of a Supervising Insurance Compliance Officer, Department of Insurance, incumbents independently perform the more complex, varied, and responsible insurance regulatory activity; investigate, identify violations, and mediate resolution of consumer complaints including inquiries by parties to the insurance contract or other interested parties or claimants involving situations that include multiple coverages or situations where there is a question of coverage or liability and typically requiring multiple contacts to achieve resolution; act as a conciliator in disputes and misunderstandings in an attempt to reach an amicable settlement between insurer and insured; report and analyze facts found in such inquiries and disputes and make recommendations; conduct examinations of the application and interpretation of policy forms, transactions, and claims practices of insurers, managing general agents, third-party administrators, or other related insurance entities either alone, as team leader, or as a full team member (sharing equal responsibility); direct the regulated insurance organization to resolve both individual and general issues, complaints, or violations of insurance laws; provide consumers with information on all relevant issues involved in each transaction; work as a team member on task forces, working groups, or projects that address technical issues or internal procedures; input claimant information directly into the Department's online database system; represent the Department at meetings with the public or industry; and do other related work.

Senior Insurance Compliance Officer (Specialist), Department of Insurance

This is the advanced journey and team/project leader level of the series. Under general direction of a Supervising Insurance Compliance Officer, Department of Insurance, incumbents independently perform the most complex, sensitive, and responsible insurance regulatory activity; investigate, identify violations, and mediate resolution of consumer complaints including inquiries wherein there is a lack of statutory clarity or involving multiple issues where resolution requires compromise by all parties in the dispute or formal legal action; initiate and lead the most complex Bureau projects including those to identify, research, and abolish trends in noncompliant activity by a single entity or those which represent an industrywide practice; investigate illegal activities that are identified through the review of data trends that are brought to the attention of the Department from outside entities; establish corrective plans with regulated entities to address noncompliant activity and monitor implementation of all corrective actions; lead examinations of those insurance organizations with the highest premium volume or claims activity or those with high levels of consumer complaints in an insurance product line or those which write a variety of coverages through multiple administrators; independently, or as team leader, organize and coordinate the development of a final report, legal referral, or alternative discipline resolution agreement suitable as a legal document for use in legal action; train staff at all lower levels; monitor consumer calls/inquiries and written case files, in a lead capacity, and serve as technical advisor to all subordinate staff; participate in Department task groups to propose and effectuate changes to regulation and/or legislation; represent the Bureau and the Department when customized examination procedures are required in the examination of financially troubled insurance organizations, those that dominate a particular product line, those that have been publicly accused of an egregious insurance practice, or where the Department is investigating allegations of a particular illegal activity; have the authority to represent the Bureau in negotiations and settlements with licensees; represent the Department in public or industry meetings; input claimant information directly into Department online database system; and do other related work.

Supervising Insurance Compliance Officer, Department of Insurance

This is the first supervisory level of this series. Under general direction of a Bureau Chief, Insurance Compliance, Department of Insurance, incumbents plan, organize, and direct the activity of all staff engaged in insurance regulatory and related work; assist in establishing Bureau policy and procedures; examine, analyze, and evaluate the facts obtained and the provisions of applicable insurance contracts; determine which cases should be referred to attorneys for disciplinary proceedings or forwarded for executive review; act as the final conciliator in the most complex disputes and misunderstandings in an attempt to reach an amicable settlement between insurer and insured; oversee multiple job sites in the examination process; review complaint file documentation or market conduct examination reports to verify that proposed resolutions to violations or examination criticisms are effective and achieve compliance; enforce consistency of operations within the Bureau; lead and participate in enforcement actions; prepare written annual performance evaluations for direct report staff; participate in the recruitment and hiring process; develop individual training plans for staff development and provide training; responsible for the most complex and sensitive projects as assigned by the Bureau Chief, Insurance Compliance, Department of Insurance; represent the Bureau at meetings and industry functions as directed by the Bureau Chief; and do other related work.

Bureau Chief, Insurance Compliance, Department of Insurance

This is the highest supervisory and management level in the series and is responsible for a highly complex program area. Under general direction, incumbents plan, organize, and direct a bureau, and are responsible for the work of professional staff engaged in administering insurance policy complaint functions relative to the mistreatment of policyholders and potential policyholders; provide protection for the California insurance consumer; prioritize assignments and the utilization of resources; oversee recruitment and retention of qualified staff; set standards for quality services and products based on sound research, customer feedback, and reasonable performance expectations; maintain operations within the budget; participate in resolution of high priority issues; enforce Bureau consistency with other Department units; communicate regularly with upper management, legal representatives, and with staff to share information on workload, accomplishments, expectations, and changes in operations; formulate policies and practices for statewide oversight of insurer market compliance; provide expert consultation to Commissioners and top management in the area of policy development on a wide range of issues relating to insurance regulations and make policy recommendations affecting program direction; regulate claims or underwriting practices and monitoring-related activities of admitted insurers; perform special Market Conduct Examinations of insurers; develop cooperative interaction with other bureaus, divisions, agencies, groups, and organizations within and outside the Department; act as technical advisor to the Insurance Commissioner and the Chief Deputy Commissioner on matters relating to legislation concerning claims or underwriting consumer affair issues; and do other related work.

Minimum Qualifications

All Levels:

Experience: Experience at an insurance company working as either (1)�an underwriter determining acceptability, coverage, appropriate rating plans, and any judgment-based rate deviations or factors; or (2) a claims adjuster investigating, evaluating, negotiating, and settling claims with respect to coverage, liability, and damages; or (3) a fire or casualty insurance agent or broker handling multiple lines of insurance coverage and making determinations regarding coverage needs, risk information, and renewal account servicing; or (4) an insurance consumer advocacy position working on consumer issues, complaints, legislation, or insurer compliance.

Insurance Compliance Officer, Department of Insurance

Either I

Education: Equivalent to graduation from college or equivalent degree approved by the Bureau for Private Postsecondary and Vocational Education under the provisions of California Education Code Division�10, Part 59, Chapter 3. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.) (Registration as a senior in a recognized institution will admit applicants to the examination, but they must produce evidence of graduation or its equivalent before they can be considered eligible for appointment.)

Or II

Experience: Two years of qualifying insurance industry experience. and

Education: Equivalent to graduation from college with a two-year degree. (Additional qualifying insurance industry experience may be substituted for the required education on a year-for-year basis.)

Or III

Experience: Three years of qualifying insurance industry experience.

Associate Insurance Compliance Officer, Department of Insurance

Either I

Experience: One year of experience in the California state service performing the duties of an Insurance Compliance Officer, Department of Insurance, Range C. (Promotional candidates who are within six months of satisfying the experience requirement for this class will be admitted to this examination, but they must fully meet the experience requirement before being eligible for appointment.)

Or II

Experience: Three years of qualifying insurance industry experience. (Experience in the California state service applied toward this requirement must be at the level of responsibility provided in the promotional pattern.) and

Education: Equivalent to graduation from college or equivalent degree approved by the Bureau for Private Postsecondary and Vocational Education under the provisions of California Education Code Division�10, Part 59, Chapter 3. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Senior Insurance Compliance Officer (Specialist), Department of Insurance

Either I

Experience: One year of experience in the California state service performing the duties of an Associate Insurance Compliance Officer, Department of Insurance.

Or II

Experience: Four years of progressively responsible qualifying insurance experience. (Experience in the California state service applied toward this requirement must be at the level of responsibility provided in the promotional pattern.) and

Education: Equivalent to graduation from college or equivalent degree approved by the Bureau for Private Postsecondary and Vocational Education under the provisions of California Education Code Division�10, Part 59, Chapter 3. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Supervising Insurance Compliance Officer, Department of Insurance

Either I

Experience: One year of experience in the California state service performing the duties of a Senior Insurance Compliance Officer (Specialist), Department of Insurance.

Or II

Experience: Two years of experience in the California state service performing the duties of an Associate Insurance Compliance Officer, Department of Insurance.

Or III

Experience: Five years of progressively responsible qualifying insurance industry experience including two years in a supervisory capacity responsible for three or more claims adjusters or underwriters. (Experience in the California state service applied toward this requirement must be at the level of responsibility provided in the promotional pattern.) and

Education: Equivalent to graduation from college or equivalent degree approved by the Bureau for Private Postsecondary and Vocational Education under the provisions of California Education Code Division�10, Part 59, Chapter 3. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Bureau Chief, Insurance Compliance, Department of Insurance

Either I

Experience: One year of experience in the California state service performing the duties of a Supervising Insurance Compliance Officer, Department of Insurance.

Or II

Experience: Two years of experience in the California state service performing the duties of a Senior Insurance Compliance Officer (Specialist), Department of Insurance.

Or III

Experience: Three years of experience in the California state service performing the duties of an Associate Insurance Compliance Officer, Department of Insurance.

Or IV

Experience: Five years of progressively responsible qualifying insurance industry experience including three years as a manager in charge of five or more claims adjusters or underwriters. (Experience in the California state service applied toward this requirement must be at the level of responsibility provided in the promotional pattern.) and

Education: Equivalent to graduation from college or equivalent degree approved by the Bureau for Private Postsecondary and Vocational Education under the provisions of California Education Code Division�10, Part 59, Chapter 3. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Knowledge and Abilities

Insurance Compliance Officer, Department of Insurance

Knowledge of: California Insurance Code and laws and regulations relating to insurance and their interpretation; basic functions and organizations of the Department of Insurance; the insurance industry; general insurance principles; analytical methods and techniques used for problem identification; and data gathering and decision making.

Ability to: Interpret and apply provisions of the California Insurance Code, laws, rules, and regulations administered by the Department of Insurance; analyze situations accurately and take effective action; use tact and good judgment in dealing with the public both on the telephone and in person; conduct interviews; learn to utilize microcomputer systems and standard software applications in the performance of work; communicate effectively; and travel countrywide to examine insurer operations (field staff only).

Associate Insurance Compliance Officer, Department of Insurance

Knowledge of: All of the above, and trends and terminology pertaining to insurance regulations; practices, procedures, and terminology; general insurance and contract law and related statutes and court decisions; and insurance claims practices and procedures.

Ability to: All of the above, and independently apply insurance statues and court decisions to specific cases; gather, organize, and summarize data; reason logically and creatively; utilize a variety of analytical and research techniques and approaches to resolve complex insurance regulatory problems; develop and evaluate alternative solutions; analyze data and present ideas and information effectively; prepare reports; gain and maintain the confidence and cooperation of those contacted during the course of work; act in a lead capacity over lower-level staff and handle sensitive client contacts; prepare complete, concise, and clear insurance proposals and reports; apply negotiation and mediation techniques to resolve consumer complaint problems; and take independent action with minimal supervision.

Senior Insurance Compliance Officer (Specialist), Department of Insurance

Knowledge of: All of the above, and compliance and enforcement techniques; project management processes; methods of preparation of project reports and project reporting techniques; and research methods and techniques.

Ability to: All of the above, and in a lead capacity, direct, train, and review the work of lower-level staff; liaison and negotiate between the Department of Insurance, other State and local agencies, and private insurance organizations; plan, organize, and provide persuasive and skilled leadership in insurance project work; and develop, review, and guide plans and projects for good results.

Supervising Insurance Compliance Officer, Department of Insurance

Knowledge of: All of the above, and principles, practices, and trends of public and business administration; administrative and court decisions affecting the regulations of the insurance industry.

Ability to: All of the above, and effectively apply compliance procedures and/or the provisions of the relevant laws, legal opinions and court decisions, and departmental policies; oversee the implementation of projects; represent the Department of Insurance before other governmental, public, and private agencies; and coordinate program operations with that of other divisions and organizations.

Bureau Chief, Insurance Compliance, Department of Insurance

Knowledge of: All of the above, and a manager's responsibility for promoting equal opportunity in hiring and employee development and promotion, and for maintaining a work environment that is free of discrimination and harassment.

Ability to: All of the above, and establish criteria, regulations, and guidelines for governmental decision making; design programs; resolve complex managerial problems; and organize, supervise, and motivate staff.

Special Personal Characteristics

All Levels:

Willingness to travel and work away from the office.

Class History