Posting number: 2026-03534
Department: DHS - AGING AND DISABILITY SERVICES DIVISION
Job classification: Unclassified
Posting type: Open Competitive
Categories: Health Care Support
The Aging and Disability Services Division (ADSD) is currently recruiting for a full-time Ombudsman position in Las Vegas, Reno, Carson City, Elko, or Ely, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following program: Office of Consumer Health Assistance (OCHA). Under the general direction of the Chief, Elder Right, the Ombudsman will assist consumers and injured employees in understanding their rights and responsibilities under health care plans, including, without limitation, the Public Employees’ Benefits Program, and policies of industrial insurance. The incumbent identifies and investigates complaints of consumers and injured employees regarding their health care plans and will refer consumers and injured employees to the appropriate agency, department or other entity that is responsible for addressing the specific complaint of the consumer or injured employee. This position facilitates access to healthcare resources for the uninsured and underinsured. The incumbent completes arbitrations for the Nevada surprise billing law. The Ombudsman will take such actions as are necessary to ensure public awareness of the existence and purpose of the services provided by OCHA. Assist consumers with filing complaints against health care facilities and health care professionals. Assign external review organizations concerning adverse determinations from a health carrier. The incumbent will build and maintain collaborative relationships with insurers, medical providers, social services, and government agencies, maintain a current knowledge of trends, policies, resources and laws pertaining to insurance benefits, including insurance laws and regulations. The mission of ADSD is to empower individuals and their support systems by providing resources for disabilities and aging - connecting Nevadans to services and improving their quality of life.
Consumer and Injured Worker Assistance
Inform, educate, and advocate for injured workers and consumers by:
-Responding to written and telephonic inquiries related to health care and workers’ compensation.
-Assisting consumers and injured employees in understanding their rights and responsibilities under their health care plans.
-Identifying, investigating, and helping resolve complaints regarding health care plans.
-Providing information in clear, understandable language about workers’ compensation and health care coverage.
-Contacting insurance companies, medical providers, and employers to advocate on behalf of injured workers and consumers.
-Assisting consumers with access to medical, dental, vision, prescription drug, and mental health services.
-Helping consumers access navigators, case managers, or facilitators for health care services.
-Assisting consumers with scheduling appointments with in network health care providers.
-Collaborating with governmental, private, and nonprofit organizations to resolve consumer issues.
-Negotiating with insurers, medical providers, or medical facilities to reach appropriate resolutions.
-Facilitating access to health care resources for uninsured or underinsured consumers.
-Assisting consumers with filing complaints against health care facilities and professionals.
-Referring complaints or the results of investigations to the Attorney General when appropriate.
-Assisting consumers with filing complaints with the Commissioner of Insurance regarding health plan issuers.
-Hearing, mediating, arbitrating, or resolving disputes between patients and hospitals.
-Assigning independent review organizations for adverse determinations from health plans.
Casework Management
-Entering timely and accurate case notes into the OCHA database.
-Preparing and sending correspondence to injured workers, consumers, insurers, and providers.
-Maintaining systems to collect and track information related to written and telephonic inquiries received by OCHA.
Community Outreach and Education
-Coordinating and participating in community outreach events.
-Building and maintaining partnerships with community resource agencies and health care organizations to increase public awareness of OCHA services.
Arbitration Responsibilities
-Conducting arbitrations to resolve disputes between out of network providers/facilities and health plans for medically necessary emergency service claims under $5,000.
Hard Skills
Health care policy knowledge
Health insurance carrier operations
Provider/facility billing and claims experience
Workers’ compensation system knowledge
Regulatory and statutory compliance
External review process administration
Arbitration or dispute resolution procedures
Report writing and documentation
Understanding of hospital billing and patient rights
Soft Skills
Strong communication and public facing skills
Empathy and consumer focused mindset
Critical thinking and problem solving
Diplomacy and conflict resolution
Integrity and ethical decision making
Ability to remain neutral and objective
Relationship building and collaboration
Adaptability and resilience
Sound judgment under pressure
Attention to detail
Professionalism and discretion
The Nevada State Contractors Board (NSCB) is committed to ensuring the integrity and professionalism of the construction industry in Nevada. The NSCB has the responsibility to promote quality construction by Nevada licensed contractors through a regulatory licensing system designed to protect the health, safety and welfare of the public.
