Insurance Claims Examiner

State of Nebraska•Lincoln, NE

3d•Onsite

About The Position

An Insurance Complaint Examiner is responsible for reviewing incoming complaints, creating inquiry correspondence to send to insurance companies and reviewing their responses for compliance with Nebraska state insurance statutes. The Examiner is also a public-facing position and is responsible for answering questions about insurance from the public.

Requirements

Bachelor degree in business or related field AND one year of experience in insurance industry or insurance regulation OR five years’ experience working in insurance industry or insurance regulation.
Employee must have successfully completed all required on-the-job training to be eligible for this classification.
Regular and reliable attendance is required.
Knowledge of: Nebraska insurance statutes and Department of Insurance rules and regulations; the overall operation of insurance companies; insurance principles and industry practices.
Ability to: Interact with insurance representatives and complainants with diverse perspectives to resolve issues; Interpret and explain insurance contracts, statutes, rules, and regulations; Identify and collect data and documents pertinent to the case; Understand and interpret relevant data and documents; interview complainants; Extract and compile statistical data; Make decisions and exercise sound judgment; Use a computer to create cases, exchange information, generate correspondence and track activity; learn new computer software programs.
Skills in: Strong written and oral communication; Microsoft Outlook, Microsoft Word, and Microsoft Excel.

Responsibilities

Responds to telephone inquiries, emails and letters from individuals requesting information pertaining to insurance practices, products and premiums, and to state and federal insurance-related law.
Reviews incoming complaints to identify potential concerns or violations and to determine what information, documentation and other evidence will be relevant and essential to the investigation.
Corresponds with all entities involved, i.e., consumers, agents, insurance company personnel, medical providers, attorneys, and employers, gathering information necessary to evaluate complaints
Reports results of reviews to consumers.
Reviews and evaluates complaint responses to ensure complainants concerns have been addressed and to ensure companies and agents have acted in accordance with Nebraska insurance statutes and Department of Insurance rules and regulations.
Drafts letters to complainants to report outcome of investigations; Drafts memorandums and organizes evidence obtained in case investigations to submit to department counsel for consideration of administrative action.
Utilizes State Based Systems (SBS) database to track case history/activity and to retrieve licensing information and extract data to create reports of company and producer complaint activity.
Other duties as assigned within the scope of the classification.

Benefits

13 paid holidays
Vacation and sick leave that begin accruing immediately
Military leave
156% (that's not a typo!) state-matched retirement
Tuition reimbursement
Employee assistance program
79% employer paid health insurance plans
Dental and vision insurance plans
Employer-paid $20,000 life insurance policy
Public Service Loan Forgiveness Program (PSLF) through the Federal government
Wide variety and availability of career advancement as the largest and most diverse employer in the State
Opportunity to be part of meaningful work and make a difference through public service
Training and Development based on your career aspirations
Fun, inviting teammates
A safe and secure environment