Job Description

Job Posting Title

Claims Review Specialist I

Agency

385 OKLAHOMA INSURANCE DEPARTMENT

Supervisory Organization

Insurance Department

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

Salary for a level I is $55,000, this position will be filled as a level I or II depending on education and experience.

DEFINITION

The Claims Review Specialist I is an entry-level position responsible for assessing and investigating consumer complaints and inquiries to ensure compliance with policy language and Title 36 regulations with a commitment to accuracy and detail. This role requires knowledge of all lines of insurance regulated by the Oklahoma Insurance Department.

DUTIES AND RESPONSIBILITIES

• Responsible for answering phone calls from the public regarding insurance questions on policies, procedures, and statutes.
• Provide technical knowledge, expertise, detailed information, and response to the public regarding various insurance questions and concerns.
• Conduct interviews with walk-in claimants to gather information and answer questions to assist claimant with filing a request for assistance. Explain process and procedures of consumer assistance division.
• Answer questions pertaining to the information submitted via feedback emails.
• Plan, organize and implement a course of action for each consumer case file to provide the most efficient, prompt, and effective response within the jurisdiction of the department.
• Review cases for contractual coverage and statutory violations under Title 36. Refer cases to appropriate areas – example: Legal, Fraud, Attorney General, Other outside agencies.
• Review and evaluate complaints for completeness. Document findings and maintain accurate coding and records through State Based System (SBS).
• Maintain effective communication with the consumer throughout the process. Serve as intermediary for the inquirer and provide direct contact with the insurer.
• Conveying responses to the consumer or explaining and facilitate the understanding of a response that may not be desirable.
• Work with senior team members to resolve discrepancies.
• Any other duties deemed necessary by the supervisor, including meetings, conferences, state of emergency issues, and outreach events and any necessary travel.
• Perform other duties as required.

KNOWLEDGE, SKILLS AND ABILITIES

• Be knowledgeable of both Property and Casualty and Life and Health insurance lines.
• Be knowledgeable of insurance policies, insurance laws, and rules under Title 36.
• Possess skill in time management and decision-making.
• Initiate, implement and complete required tasks to resolve all insurance questions, concerns, or complaints.
• Ability to analyze information and identify errors. Exercise judgment in reviewing claim files; handle confidential work with tact and discretion.
• Maintain effective working relationships.
• Communicate effectively.

EDUCATION AND EXPERIENCE:

Level I- Bachelor’s degree or equivalent education and experience. Experience in the insurance field with account management or customer assistance, demonstrating evidence of knowledge and skills to perform the tasks of the job. Industry designation related to consumer assistance, CISR, considered a plus.

DEFINITION

Under limited supervision, a Claims Review Specialist II analyzes and investigates Property and Casualty, and Life and Health consumer complaints and inquiries received by the Consumer Assistance/Claims Division of the Oklahoma Insurance Department.

DUTIES AND RESPONSIBILITIES

• Conduct interviews with walk-in claimants to gather information and answer questions in an effort to assist claimant with filing a request for assistance. Explain process and procedures of consumer assistance division.
• Answer questions pertaining to the information submitted via feedback.
• Any other duties deemed necessary by the supervisor, including meetings, conferences, state of emergency issues, and outreach events and any necessary travel.
• Serve as intermediary for the inquirer and provide direct contact with the insurer.
• Plan, organize and implement a course of action for each consumer inquiry to provide the most efficient, prompt, and effective response within the jurisdiction of the department. Maintain effective communication with the consumer throughout the process.
• Convey response to the consumer or explain and facilitate the understanding of a response that may not be desirable.
• Provide technical knowledge, expertise, detailed information, and response to the public regarding various insurance questions and concerns.
• Responsible for answering phone calls from the public regarding insurance questions on policies, procedures, and statutes.
• Backup to the Claims Processor Reviewer.
• Perform other duties as required.

KNOWLEDGE, SKILLS AND ABILITIES

• Be knowledgeable of both Property and Casualty and Life and Health insurance lines.
• Be knowledgeable of insurance laws, rules, and policies.
• Possess skill in time management and decision-making.
• Initiate, implement and complete required tasks to resolve all insurance questions, concerns, or complaints.
• Exercise judgment in reviewing claim files; handle confidential work with tact and discretion.
• Maintain effective working relationships.
• Communicate effectively.

EDUCATION AND EXPERIENCE:

Level II- Bachelor’s degree or equivalent education and experience. Experience in the insurance field with account management or customer assistance, demonstrating evidence of knowledge and skills to perform the tasks of the job. Industry designation related to consumer assistance, CISR, considered a plus.

NOTE:

Upon hire, any applicant who is licensed as a producer/agent, adjuster or is otherwise affiliated with any entity that is regulated by the department must surrender their license and terminate any financial or non-financial affiliation with the entity that is regulated by the department. The selected applicant must pass a background check. Individual may be required to pursue NAIC designations as job duties require.

TELEWORK:

This position may be eligible for telework each week under OID’s Telework Program.

To see a complete list of benefits offered by the State of Oklahoma to employees of the state click on the following link. https://oklahoma.gov/omes/services/employee-benefits.html Equal Opportunity Employer

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub

If you are needing any extra assistance or have any questions relating to a job you have applied for, please click the link below and find the agency for which you applied for additional information:

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