STATE OF NEW HAMPSHIRE
HUMAN RESOURCES
CLASSIFICATION: INSURANCE CLAIMS REPRESENTATIVE
Class Code: 5248-22
Date Established: 03-21-91
Occupational Code: 7-2-4
Date of Last Revision: 12-28-01
BASIC PURPOSE: To assist and represent insurance
consumers in receiving benefit rights and other advantages of insurance, and to
assist in mediating disputes between insurers and insurance consumers.
CHARACTERISTIC DUTIES AND RESPONSIBILITIES:
·
Presents information
and assistance to insurance consumers or their legal representatives concerning
consumer rights and the corresponding rights of their insurers.
·
Reviews summaries and
reports or determinations used in requesting an appeal, redetermination or
reopening.
·
Prepares and
transmits appeals to insurers made on behalf of aggrieved insurance consumers.
·
Prepares and presents
reports summarizing results of hearings and other administrative actions taken
on behalf of consumers to resolve complaints, provide information, or to render
other services.
·
Analyzes operating
procedures and makes recommendations to agency administrators for necessary
modification in work methods.
·
Participates in
hearings held for the purpose of mediating disputes between insurers and insurance
consumers.
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DISTINGUISHING FACTORS:
Skill: Requires skill in developing formats
and procedures for special applications OR in investigating and reviewing the
use of equipment and data for a specialized function.
Knowledge: Requires logical or scientific
understanding to analyze problems of a specialized or professional nature in a
particular field.
Impact: Requires responsibility for achieving
direct service objectives by assessing agency service needs and making
preliminary recommendations for the development of alternative short-term
program policies or procedures.
Errors at this level result in incomplete assessments or misleading
recommendations causing a disruption of agency programs or policies.
Supervision: Requires partial supervision of other
employees doing work which is related or similar to the supervisor, including
assigning job duties, providing training, giving instructions and checking
work.
Working Conditions: Requires performing regular job
functions in a controlled environment with minimal exposure to disagreeable job
elements and little risk of hazard to physical or mental health.
Physical Demands: Requires light work, including
continuous walking or operating simple equipment for extended periods of time
as well as occasional strenuous activities such as reaching or bending.
Communication: Requires reviewing summaries and
reports and making management level decisions to solve problems or to achieve
work objectives as well as articulating and expressing those solutions and
goals. This level also requires
formal presentations of solutions and goals to employees and the general public
to increase the responsiveness of the agency toward the demands of its client
system.
Complexity: Requires coordinating a combination of
diverse job functions in order to integrate professional and technical agency
goals. This level also requires
considerable judgment to implement a sequence of operations or actions.
Independent Action: Requires objective assessment in
analyzing and developing new work methods and procedures subject to periodic
review and in making decisions according to established technical, professional
or administrative standards.
MINIMUM QUALIFICATIONS:
Education: Bachelor's degree from a recognized
college or university, with a major study in business administration,
insurance, or accounting.
Experience: Four years' experience in a managerial,
supervisory or senior technical position with a large insurance company or
independent claims adjusting organization in a position directly responsible
for negotiating settlements under the various forms of coverage such as fire,
liability, casualty, accident and health and life insurance.
License/Certification: None required.
RECOMMENDED WORK TRAITS: Considerable knowledge of state
statutes relating to insurance coverage and policies. Considerable knowledge of the regulations promulgated by the
state Insurance Department as well as the regulations under which insurance
companies operate. Considerable
knowledge of the principles of administration, systems management and insurance
company development as applicable to the consumer protection area. Ability to express ideas clearly and
concisely, both orally and in writing.
Ability to establish and maintain amiable relations between insurance
purchasers and insurance companies.
Ability to develop statistical reports with evidence and recommendations
based upon evidentiary hearings.
Ability to objectively evaluate information received and to make sound
recommendations. Must be willing
to maintain appearance appropriate to assigned duties and responsibilities as
determined by the agency appointing authority.
DISCLAIMER STATEMENT: This class specification is descriptive
of general duties and is not intended to list every specific function of this
class title.
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Last Updated 01/07/03
URL: http://www.nh.gov/hr/classspec_i/5248.htm