Claims Review Specialist III

Job Posting Title

Claims Review Specialist III

Agency

385 OKLAHOMA INSURANCE DEPARTMENT

Supervisory Organization

Insurance Department

Job Posting End Date (Continuous if 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

Will be filled as a level II or III, based on education and experience. Salary range for the II to III is $50,000-$65,000.

Job Description

DEFINITION:

Under limited supervision, analyze and investigate Property and Casualty 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 feedbacks
• 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
• Level III will have mentoring responsibilities
• Perform other duties as required.

              

KNOWLEDGE, SKILLS AND ABILITIES:

• 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.

Level III-Bachelor's degree and five years’ experience in the insurance field or an equivalent combination of education and experience including at least one of the following certifications/designations: ACS, CISR.

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.

For benefits offered by the State of Oklahoma to employees of the state, please use this link to access the Office of Human Capital Management benefits page at https://omes.ok.gov/services/employee-benefits

EEO/AA

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.