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You are here: www.tdi.texas.gov . jobs . postings . job17196

Texas Department of Insurance

The Texas Department of Insurance (TDI) is a state agency responsible for both consumers and the insurance industry. We work to fulfill our legislative mandate to regulate the insurance industry, administer the Texas workers’ compensation system, and promote a healthy insurance marketplace, while also protecting the people and the businesses that are served by insurance. We take our responsibility to Texans seriously and strive for excellent customer service through our professional attitude, competence and efficiency.

Important notice: Read before you apply

Veterans’ Preference:

To receive veterans’ preference, applicants must provide at least one the following documents with their State of Texas Application:

  • a copy of the DD 214, member #4;
  • a statement of compensation from the Veterans Benefits Administration; or
  • a copy of the DD 1300.

Applicable Military Occupational Specialty (MOS) codes are included, but not limited to the following: No military equivalent at this time.

Additional Military Crosswalk information can be accessed at:

http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_Insurance.pdf

Current Opportunity: Insurance Specialist III

Internal/External Posting – TDI Employees and General Public

The Insurance Specialist works in the Managed Care Quality Assurance (MCQA) Office and involves independent review and analysis of certification applications and forms to determine compliance with statutes and rules.


This position:

  • reviews new applications, renewals, filings, and updates to determine compliance with applicable statutes and regulations for Utilization Review Agents, Independent Review Organizations (IROs), Workers’ Compensation Health Care Networks and Health Maintenance Organizations;
  • reviews network adequacy reports, waiver requests and access plans to determine compliance with applicable statutes and regulations for Health Maintenance Organizations, Preferred Provider Benefit Plans, and Exclusive Provider Benefit Plans;
  • reviews filings from Provider Network Contracting Entities for registration or exemption to determine compliance with applicable statutes and regulations;
  • may assist with implementation of new legislation, including rule development;
  • composes clear and concise written correspondence regarding violations of insurance statutes and regulations;
  • uses the Texas Insurance Code and Texas Administrative Code to research responses to inquiries regarding the various functions of the MCQA office within established timeframes;
  • provides consultative and technical information to agency and program staff, other government agencies, community organizations, and consumers verbally and in writing;
  • participates in meetings with regulated entities, other governmental agencies and agency staff;
  • performs data entry in databases for applications, renewals, and updates;
  • prepares and recommends legal referrals to agency Compliance Intake Office;
  • assists with review of utilization review policies and procedures submitted in Workers’ Compensation Health Care Network certification applications;
  • assigns independent review requests and performs audits of IRO decisions within established timeframes; and
  • participates in cross-training and multiple functions within the MCQA Office.

Qualifications

This position requires sixty college hours.  Education and experience relevant to position requirements may be substituted for one another on a year-for-year basis.


Additionally, this position:

  • requires eighteen months experience in health care, regulatory, insurance, legal, or plan administration environment; and
  • prefers two years’ of experience in insurance and utilization review.


This position requires demonstrated knowledge of:

  • Texas Insurance Code, Texas Administrative Code, and/or other applicable codes and statutes with regard to managed care (TIC Chapters 843, 1301, 4201, 4202, and 1305; 28 TAC Chapters 3, 10,11,12,and 19); and
  • general office practices and administrative procedures.

This position requires demonstrated skill in:

  • personal computer using applications for Microsoft Word, Excel, and Outlook;
  • managing multiple competing priorities;
  • problem solving, decision making and planning; and
  • analyzing related data and using conclusions to reach resolution.

This position requires the demonstrated ability to:

  • apply critical thinking to analyze and solve work problems;
  • take personal responsibility for completing assigned tasks;
  • think and act independently within division and agency guidelines;
  • make decisions based on sound reasoning;
  • comprehend, learn, retain, and explain rules, policies, procedures and practices;
  • analyze and resolve issues regarding insurance statutes and regulations;
  • accurately compose and generate clear and concise written correspondence;
  • perform accurate and timely data entry in Microsoft 2013 Excel, and Oracle database; and
  • establish and maintain effective relations with consumers, industry representatives, and department staff.

 

EMPLOYMENT WILL BEGIN ON OR AFTER SEPTEMBER 1, 2017

 

Position Details

Opening Date:07/17/2017
Functional Title:Insurance Specialist III
Classification Title:Insurance Specialist III
Status:Internal/External Posting – TDI Employees and General Public
Application Deadline:Until Filled
Pay Group:B16
Monthly Salary: $3,109.83
Annual Salary:$37,317.96
Job Posting Number:17-196
Division:Financial Regulation Division/Managed Care Quality Assurance Office
Location:333 Guadalupe St., Austin, TX 78701
Travel Required:5 %

 

For more information, contact:

Last updated: 07/17/2017

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