Claims Review Specialist II

State of Oklahoma•Oklahoma City, OK

2d•Hybrid

About The Position

DEFINITION: Under limited supervision, analyze and investigate 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.

Requirements

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.
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.

Nice To Haves

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

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.