Claims Review Specialist I

State of Oklahoma • Oklahoma City, OK

6d • Hybrid

About The Position

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.

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.

Requirements

• 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.
• 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.
• 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.

Nice To Haves

• Industry designation related to consumer assistance, CISR, considered a plus.

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.
• Backup to the Claims Processor Reviewer.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level