Life & Health Complaints Analyst I

Georgia Department of Revenue•Atlanta, GA

43d•Onsite

About The Position

Under general supervision, the Life & Health Complaints Analyst I reviews for compliance with applicable laws in determining eligibility for complaints. In addition, this role provides professional-level support directly to the department.

Requirements

Associate degree from an accredited college or university and three (3) years of job-related experience; or one (1) year of experience required at the lower level Complnc Business Analyst 1 (RCP030) or position equivalent.

Responsibilities

Obtain information on claims rejected for payment by life, accident and/or health insurers by interviewing policyholders and claimants to determine the validity of the inquiry.
Evaluate complaints directed against insurers concerning unfair insurance trade practices as defined by Georgia law by reviewing laws enacted against such practices to determine a basis for action on such complaints.
Analyze insurance policies of complainants by evaluating and interpreting the contract to determine the extent of coverage, the exclusions specified, and the conditions affecting the payment of claims.
Analyze facts by reviewing and evaluating the incidents related to claims to determine whether policy coverage extends to such incidents.
Request the claims and underwriting files of insurers for review to determine "good faith" investigations of claims and to determine if they have met the obligations set forth in the policy.
Analyze the evidence by reviewing and evaluating the reasons for the claims' rejection to determine the basis.
Recommend payment within a reasonable time by citing sections of the Georgia Code or policy provisions that pertain to the insurer's obligation if it is decided that the insurer is liable.
Draft concise responses to complex inquiries.
Conduct research to compile information needed to generate reports, complete projects, and accurately respond to questions and concerns.
Perform other duties an assigned.