Insurance Consumer Analyst I

State of North Carolina • Wake, TX

12d • $39,671 - $48,410 • Hybrid

About The Position

The primary purpose of this position is to provide counseling, education, and assistance to consumers regarding health insurance issues affecting Medicare beneficiaries through a national toll-free telephone line, in-person meetings, and virtual assistance. This position is responsible for assessing consumers’ needs, gathering and verifying accurate information, and providing clear and appropriate responses to questions and inquiries.

The position requires extensive knowledge of Medicare, Medicare Supplement insurance, Long-Term Care insurance, Medicare Managed Care, Medicare Prescription Drug Plans, medical claims procedures, and Medicare fraud, waste, and abuse. When an inquiry requires additional research, the position will refer the issue to the appropriate staff member for further review and coordinate follow-up with the consumer to ensure the question or concern is addressed.

The position may also make appropriate referrals to other sources of assistance, including social service organizations, state and federal agencies, and community resources, based on the consumer’s specific needs and circumstances.

Requirements

• Bachelor's degree in business or economics or a related program from an appropriately accredited institution and one year of experience in insurance underwriting, claims, or policyholder service; or an equivalent combination of education and experience.
• Extensive knowledge of Medicare, Medicare Supplement insurance, Long-Term Care insurance, Medicare Managed Care, Medicare Prescription Drug Plans, medical claims procedures, and Medicare fraud, waste, and abuse.

Nice To Haves

• Strong knowledge of health insurance laws, regulations, policies, procedures, and Medicare laws and claims practices.
• Extensive knowledge of Medicare Supplement, Medicare Managed Care, Medicare Prescription Drug Plans, and Long-Term Care insurance products, including the ability to compare and differentiate among various products to effectively educate, advise, and assist consumers.
• Strong communication, organizational, and interpersonal skills, with the ability to accurately assess consumer needs, gather information, document inquiries, and manage follow-up activities.
• Demonstrated ability to communicate complex health insurance and Medicare-related information clearly, accurately, and concisely by telephone, in person, and through virtual platforms, primarily to senior citizens and individuals with disabilities.
• Demonstrated patience, professionalism, empathy, and courtesy when assisting elderly and disabled individuals, particularly when addressing complex, sensitive, or potentially confusing insurance-related questions and concerns.

Responsibilities

• Provide counseling, education, and assistance to consumers regarding health insurance issues affecting Medicare beneficiaries through a national toll-free telephone line, in-person meetings, and virtual assistance.
• Assess consumers’ needs, gather and verify accurate information, and provide clear and appropriate responses to questions and inquiries.
• Refer issues requiring additional research to the appropriate staff member for further review.
• Coordinate follow-up with the consumer to ensure questions or concerns are addressed.
• Make appropriate referrals to other sources of assistance, including social service organizations, state and federal agencies, and community resources, based on the consumer’s specific needs and circumstances.

Benefits

• 12 Annual paid Holidays
• North Carolina State Health Plan administered by AETNA
• Supplemental Benefits including: Flexible Spending Accounts, Accident Insurance, Cancer & Specified Disease, Critical Illness, Dental and Vision
• NC State Retirement (TSERS)
• WeSave Employee Discounts

What This Job Offers

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