Life & Health Complaints Analyst I

Insurance Department of the State of Georgia; Walnut Hills (OH); On-site; USD 43,000 - 58,000; Full time

Job summary

The Insurance Department of the State of Georgia is seeking a Life & Health Complaints Analyst I to review complaints for compliance and determine eligibility. You will interview policyholders to establish the validity of inquiries and analyze policy provisions to assess coverage and payment obligations.

Under supervision, draft responses, prepare reports, and support investigations of life, accident and health claims. A associated degree and relevant experience are required.

Qualifications

• Associate degree from an accredited college or university.
• Three years of job-related experience; or one year at the lower level Complnc Business Analyst 1.

Responsibilities

• Review for compliance with applicable laws in determining eligibility for complaints.
• Interview policyholders and claimants to determine the validity of inquiries.
• Evaluate insurance contracts to determine coverage, exclusions and payment conditions.
• Draft concise responses to complex inquiries and support reporting and projects.
• Conduct research and assist in investigations related to life, accident and health complaints.

Education

Associate degree from an accredited college or university

Job description

Explore a World of Opportunity with the State of Georgia! We are the force that drives Georgia! Georgia State Government is a large enterprise, composed of various agencies and entities with a common goal to improve the lives of Georgia's more than 10 million citizens! Join Team Georgia and impact lives everyday while receiving a robust benefits package designed for every stage of your career!

Job Title: Life & Health Complaints Analyst I

Agency: Insurance Department of the State of Georgia

Job Requisition ID: JR0000004206

Shift: Not Applicable (United States of America)

Compensation Details: $50,000.00

Job Description:

Under general supervision, the Life & Health Complaints Analyst I reviews for compliance with applicable laws in determining eligibility for complaints. In addition, this role provides professional-level support directly to the department. Obtain information on claims rejected for payment by life, accident and/or health insurers by interviewing policyholders and claimants to determine the validity of the inquiry. Evaluate complaints directed against insurers concerning unfair insurance trade practices as defined by Georgia law by reviewing laws enacted against such practices to determine a basis for action on such complaints. Analyze insurance policies of complainants by evaluating and interpreting the contract to determine the extent of coverage, the exclusions specified, and the conditions affecting the payment of claims. Analyze facts by reviewing and evaluating the incidents related to claims to determine whether policy coverage extends to such incidents. Request the claims and underwriting files of insurers for review to determine "good faith" investigations of claims and to determine if they have met the obligations set forth in the policy. Analyze the evidence by reviewing and evaluating the reasons for the claims' rejection to determine the basis. Recommend payment within a reasonable time by citing sections of the Georgia Code or policy provisions that pertain to the insurer's obligation if it is decided that the insurer is liable. Draft concise responses to complex inquiries. Conduct research to compile information needed to generate reports, complete projects, and accurately respond to questions and concerns. Perform other duties an assigned.

Minimum Qualifications:

Associate degree from an accredited college or university and three (3) years of job-related experience; or one (1) year of experience required at the lower level Complnc Business Analyst 1 (RCP030) or position equivalent.

Equal Employment Opportunity Employer

The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services. Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.

Georgia State Government is a large enterprise, composed of various entities with a common goal to improve the lives of Georgia's 10 million citizens. With nearly 62,000 employees, we are one of the single largest employer in the state. Public service opportunities stretch across the state as employees live and work in all 159 counties. From traditional fields such as accounting, nursing, and engineering to unique fields like forestry and natural resources management, Georgia state government provides a world of opportunity.