This information is for reference only. These classifications are no longer valid and were replaced 7/1/2020.
This is entry-level professional work in the Department of Insurance or the Missouri Public Service Commission responding to inquiries and complaints from the general public.
An employee in this class is responsible for receiving, analyzing, investigating and resolving complaints filed by consumers against insurance companies, health services corporations, health maintenance organizations, third party administrators, utilization review firms or against investor-owned electric, gas, telephone, water and sewer utilities. Work involves providing consumers with requested information and explanations, preparing complaint forms and serving as liaison between complainants and insurance carriers or utilities to resolve disputes or claims. General supervision is received from a Consumer Services Supervisor; however, the employee exercises judgment in routine contacts with consumers and insurance companies
Applicants must meet one of the following eligibility requirements:
(The following minimum qualifications will determine merit system eligibility and may be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
Graduation from an accredited four-year college or university with specialization in insurance, risk management, business or public administration, social sciences or closely related areas.
OR
Four years of professional or technical experience in insurance, investigations or public relations, of which two years must have been in one or more of the areas listed below; and possession of a high school diploma or proof of high school equivalency.
This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.
Provides advice to consumers regarding insurance laws and regulations, types of policies and products available, or regarding utility laws, regulations and tariffs.
Investigates and responds to consumer inquiries and complaints regarding insurance claims procedures, policy provisions, settlement offers, claim denials, or regarding utility tariffs, billing practices and services; enters complaint information into computer system.
Refers complaints involving suspected insurance agent fraud to investigative staff; assists in gathering evidence of unacceptable agent practices, as necessary.
Reviews and analyzes data to determine validity of complaints and to ensure insurance company compliance with contract requirements, state insurance laws, rules and regulations, or to ensure utility company compliance with tariffs, state laws, rules and regulations; refers cases of non-compliance to legal staff with recommendations for action or sanctions.
Requests documentation, information and assistance from insurance companies or utilities; serves as liaison and attempts to resolve disputes between complainants and insurance carriers or utilities.
Maintains records of the investigation and resolution of consumer complaints and inquiries.
Performs other related work as assigned.
Working knowledge of insurance and/or utility industry practices, terminology, tariffs, claims processing and complaint procedures.
Working knowledge of state laws, rules and regulations, and court decisions affecting the insurance or utility industries.
Working knowledge of all lines of insurance and types of policies and products offered to Missouri consumers.
Ability to interpret and explain insurance company or utility policies and practices.
Ability to communicate effectively and to prepare clear and concise reports.
Ability to analyze facts and present logical solutions to problems.
Ability to establish and maintain effective working relationships with other employees, consumers, insurance company or utility representatives, state officials and the general public.
Ability to operate a computer terminal and dictation equipment.