Health Insurance Consumer Affairs Officer

Description

Idaho Department of Insurance Opportunity

Are you an experienced health insurance professional looking to serve the public by answering health insurance questions and investigating health insurance complaints?

The Idaho Department of Insurance (DOI) is seeking a Consumer Affairs Officer with health insurance experience to provide customer service to the public. The ideal candidate will have experience helping consumers with health insurance questions and health insurance issues. The selected candidate will receive training on health insurance regulation as well as support from an experienced team (Consumer Affairs section). Applicants must be willing to take assessment/examination and receive a passing score in order to be considered for the position.

Hiring managers are continuously considering applications for this position. This job announcement will be closed if the position is filled prior to the closing date. We highly encourage individuals from all different experiences and industries to apply to learn more about this great opportunity at DOI!

EXAMPLE OF DUTIES:

• Reviews, analyzes, investigates, and resolves insurance-related complaints and problems.
• Provides technical information and assistance to the insurance industry and the public.
• Analyzes consumer complaints relating to the regulated health insurance industries to determine whether a violation of Idaho laws or a breach of contract provisions has occurred.
• Requests documentation, information, and assistance from regulated companies or licensees in resolving complaints and problems.
• Negotiates resolution of complaints.
• Investigates code violation cases.
• Prepares documentation and submits to supervisor for legal referral.
• Responds to technical questions from insurance companies, adjusters, agents, etc., regarding claims procedures, underwriting, and insurance laws, regulations, and procedures.
• Reviews insurance policies and related documents to assure compliance with Idaho insurance laws and regulations.
• Provides information, interpretations, and assistance to the public in a variety of insurance matters including alternative coverage's, policies, and legal requirements for coverage.

MINIMUM QUALIFICATIONS:

Some knowledge of:

• Investigative techniques and interviewing techniques. Typically gained by six (6) months' full-time professional work experience where job duties included gathering and evaluating information relative to the issuance of an insurance policy or the payment of a claim; OR more than six (6) month's full-time professional work experience where major job functions involved interviewing and investigation or investigative techniques; OR have successfully completed college-level coursework related to interviewing and investigation techniques; OR one (1) year of full-time professional work experience where job duties included gathering and evaluating information relative to the issuance of an insurance policy or the payment of a claim; OR more than one (1) year of full-time professional work experience where major job functions involved interviewing and investigation or investigative techniques; AND have successfully completed college-level coursework related to interviewing and investigation techniques.

Experience:

• Mediating conflicts. Typically gained by currently taking mediation or negotiation-related college-level coursework or related training; OR less than six (6) months' full-time professional work experience where I am required to mediate conflicts or negotiate the resolution of complaints as a major job responsibility, whether for pay or as a volunteer OR have successfully completed mediation or negotiation-related college-level coursework or related training; OR more than (6) months’ full-time professional work experience where I am required to mediate conflicts or negotiate the resolution of complaints as a major job responsibility, whether for pay or as a volunteer; OR have successfully completed mediation or negotiation-related college-level coursework or related training; AND more than one (1) year of full-time professional work experience where I am required to mediate conflicts or negotiate the resolution of complaints as a major job responsibility, whether for pay or as a volunteer.

• Analyzing and compiling information into meaningful written correspondence and reports. Typically gained by more than six (6) months' full-time professional work experience where duties included analyzing financial or insurance policy benefits and providing in a written format information addressing the problem.
• Using a personal computer. Typically gained by having more than six (6) month's professional work experience using a personal computer with programs such as basic Microsoft Word, Outlook, and Excel or equivalent programs; OR I have successfully completed college-level computer training courses that covered both basic and intermediate skills training.
• Making oral presentations before groups. Typically gained by having more than six (6) month's experience making presentations in any group setting; OR I am currently taking a college-level speech or communication class; OR successful completion of a college level course in each area; OR a three-day seminar in each subject.

MINIMUM QUALIFICATION SPECIALTIES:

Insurance -

Good knowledge of the insurance industry's working areas (Health and Disability) including:

• Marketing or
• Underwriting or
• Claims processing or
• Policyholder services

This is typically gained by at least one (1) year of full-time professional work experience where the major job functions involved detailed knowledge of health and disability insurance products, i.e., selling, adjusting claims, underwriting, or policyholder service. Experience working with workers compensation insurance and/or in medical billing for a provider does not qualify as “detailed knowledge of health and disability insurance products” as minimally required for this position. To obtain proper credit your answer must be supported in your resume.

Some knowledge of:

• Legal and medical terminology commonly used in insurance contracts. Typically gained by more than six (6) months professional work experience with legal and medical terminology that is used in insurance contracts; OR successful completion of a college level course in each area; OR a three-day seminar in each subject.
• The functions and responsibilities of insurance agents and adjusters. Typically gained by successful completion of coursework, seminars, and/or training that specifically dealt with the functions and responsibilities of insurance agents and adjusters; OR at least one (1) year of full-time professional work experience in either of these areas. Experience working with workers compensation insurance and/or in medical billing for a provider does not meet the minimum qualifications for this position. To obtain proper credit your answer must be supported in your resume.

Experience:

• Interpreting insurance contracts and coverage relating to health and disability insurance
• Interpreting, applying, and explaining insurance policies and laws

This is typically gained by more than six (6) months' full-time professional work experience where duties included interpreting, applying, and explaining insurance policies and/or laws.

SUPPLEMENTAL INFORMATION:

The Idaho Department of Insurance embraces diversity and equal opportunity in a meaningful way. Our agency is committed to building a team that represents a variety of backgrounds, perspectives, and skills. This includes hiring talented staff members who have bilingual skills, which is an on-going goal for the DOI. We strive to create an inclusive work culture that encourages, supports, and celebrates the diverse voices of our team members. This helps to fuel innovation and a connection to customers and the communities served in Idaho.

The mission of the Department of Insurance is to serve and protect Idahoans by equitably, effectively, and efficiently administering the Idaho Insurance Code and the International Fire Code.

The Department of Insurance is in downtown Boise across the street from the state's Capitol Building. Boise consistently receives top accolades as one of the best places to live in the country! To learn more about Idaho DOI and the important work we do, go to the DOI website, and follow us on Facebook, Twitter, and LinkedIn.

BENEFITS:

This benefited position enjoys:

• Excellent medical, dental, and vision health plans
• Nationally recognized PERSI retirement benefits
• Paid sick and vacation leave accrual upon hire
• Parental leave
• 11 paid holidays annually
• A healthy work-life balance
• Career growth and professional development opportunities

For additional information related to benefits and/or State programs visit: https://dhr.idaho.gov/StateEmployees/Benefits.html.

EEO/ADA/VETERAN:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email ada.coordinator@dhr.idaho.gov.

Preference may be given to veterans who qualify under state and federal laws and regulations.