Insurance Consumer Analyst II

Insurance • Wake County, NC

9d • Hybrid

About The Position

The mission of the North Carolina Department of Insurance is to promote a stable insurance market through unbiased regulation and to protect the lives and property of every citizen in all 100 counties while fostering superior, user-friendly service, courtesy, and respect. Our agency licenses insurance agents, adjusters, bail bondsmen and more, along with investigating fraud matters involving insurance consumers and any entity or individual regulated by the Department. In an ever-changing environment, it is the vision of the Department of Insurance to maintain the stabilization of the insurance industry in order to provide more products, competitive prices and consumer protection.

Salary Recruitment Range: $55,515 - $65,088 Salary Grade: NC11

The posting will close at 11:59 p.m. the night before the closing date. This position currently qualifies for a hybrid telework option with routine office and up to one remote workday per week. The NC Department of Insurance trusts our employees to be self-motivated and successful in hybrid/remote roles. Telework options are subject to change at the discretion of management.

Primary Purpose of the Position: The primary purpose of this position is to ensure that life and health insurers comply with relevant laws, rules and policy contracts in their dealings with consumers. This is accomplished through an analysis of the regulatory factors related to any given complaint, researching policy provisions, state law, federal laws relating to health insurance including the Affordable Care Act and the No Surprise Act, and reliance on considerable knowledge of insurer and agency operations. Using a case management model, this position is responsible for communicating with complainants, ascertaining whether the complaint has all relevant information, obtaining additional information if needed, identification of any areas of potential non-compliance, research of insurance issues, consult with relevant areas of the Department responsible for rating and forms/filing to ensure that company responses are accurate, communicating with industry on areas of concern, require corrective action from industry and documentation of the complaint to comply with national NAIC coding standards. This position must also recognize areas of non-compliance that have the potential to be wide-spread and impact large numbers of consumers. This position must have considerable technical knowledge as well as interpersonal skills to communicate with complainants who possess any level of education. The ability to express oneself clearly and concisely in verbal and written form is necessary for this position. This position must communicate progress of the complaint process to the complainant and answer any questions or address any concerns the complainant has through the complaint handling process. This position must communicate with the Section Manager when significant areas of non-compliance are discovered and obtain as much information as is necessary to refer the matter for further action to other Department Divisions.

Requirements

• Bachelor's degree in business, economics, or a related program from an accredited institution.
• Two years of experience in insurance underwriting, claims, or policyholder service.
• Equivalent combination of education and experience.
• Ability to express oneself clearly and concisely in oral and written form.
• Ability to translate technical insurance language into layman terminology.

Nice To Haves

• Considerable knowledge of Life and Health insurance principles and practices.
• Considerable knowledge of North Carolina insurance laws and regulations.
• Considerable knowledge of Life and Health insurance policies and coverages.
• Considerable knowledge of legal processes and insurance-related court rulings.
• Considerable knowledge of medical/health terminology and costs.
• Ability to make presentations before groups of consumers and/or insurance and regulated entity personnel or other interested/affected parties.

Responsibilities

• Analyze regulatory factors related to consumer complaints.
• Research policy provisions, state laws, and federal laws (including ACA and No Surprise Act).
• Communicate with complainants to gather necessary information.
• Identify potential areas of non-compliance by insurers.
• Consult with internal departments (rating, forms/filing) to ensure accurate company responses.
• Communicate with the insurance industry regarding concerns and require corrective actions.
• Document complaints according to NAIC coding standards.
• Identify widespread non-compliance issues impacting numerous consumers.
• Communicate complaint process progress to complainants.
• Answer complainant questions and address concerns.
• Escalate significant non-compliance issues to the Section Manager for further action.

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: Mid Level