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You are here: Home . jobs . postings . job18136

Texas Department of Insurance

The Quality of Care Examiner performs tasks to determine and report in writing regulatory compliance by managed care entities.

Important notice: Read before you apply

Veterans’ Preference:

To receive veterans’ preference, applicants must provide at least one of 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 one of the following: 56M, 68J, PS, 018, 0111, 4430, 3A1X1, 68, 3A

Additional Military Crosswalk information can be accessed at: https://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_ProgramManagement.pdf

Veterans: Go to www.texasskillstowork.com for assistance with translating your military work experience and training courses into civilian job terms, qualifications/requirements and skill sets.

 

Current Opportunity: Examiner

Internal/External Posting – TDI Employees and General Public

The Quality of Care Examiner performs tasks to determine and report in writing regulatory compliance by managed care entities.


This position:

  • conducts a random review of complaint, claim, credentialing, and utilization review files to determine compliance with the Texas Insurance Code and Texas Administrative Code and other applicable statutes;
  • reviews network adequacy, questionnaires, plan operations, and quality improvement documents for compliance with the Texas Insurance Code and Texas Administrative Code and other applicable statutes and rules;
  • prepares written reports using the applicable statutes and rules to compose clear and concise written correspondence regarding violations of insurance statutes and regulations;
  • prepares and recommends legal referrals to agency Compliance Intake Office;
  • meets with company management and representatives to discuss resolution of issues or problems relating to examination findings;
  • provides technical information in writing, in person, and over the telephone to company management and representatives;
  • updates internal policies, procedures and checklists for examination functions;
  • assists with review and analysis of proposed legislation and legislative implementation and revision of exam tools;
  • travels to participate in the on-site examination process with an overnight stay; and
  • assists with special projects.

Qualifications

Graduation from an accredited four-year college or university with a degree in accounting, finance, insurance, or business administration.  Education and experience relevant to position may be substituted for one another on a year-for-year basis. 


Additionally, this position:

  • requires two years of experience in health insurance, health claim payments, utilization review, health complaints, or credentialing of health care providers.


This position requires demonstrated knowledge of:

  • Texas Insurance Code, Texas Administrative Code, and/or other applicable codes and statutes with regard to managed care;
  • health insurance regulations;
  • business or program terminology, spelling, punctuation, grammar, typing formats, and word processing techniques and procedures; and
  • general office practices and administrative procedures.

This position requires demonstrated skill in:

  • communicating technical information professionally and effectively, both verbally and in writing, with all levels of employees and the general public;
  • developing goals and objectives;
  • problem solving, decision making, and planning;
  • analyzing related data and using conclusions to reach resolution; and
  • using Microsoft Office software applications, including Word, Excel, and Outlook.

This position requires the demonstrated ability to:

  • apply critical thinking to comprehend complex regulatory rules and statutes to determine compliance or solve problems;
  • draft clear and concise reports of findings;
  • organize, prioritize, coordinate, and manage multiple tasks and special projects in order to meet established timelines;
  • take personal responsibility for completing assigned tasks;
  • make decisions based on sound reasoning;
  • understand and carry out complex instructions;
  • prepare and maintain complex records and files;
  • make decisions in accordance with rules, regulations, and procedures;
  • maintain the confidentiality of sensitive information;
  • offer positive and constructive ideas, encouragement and support to other staff members, while upholding the agency’s core values; and
  • establish and maintain an effective and harmonious working relationships with all levels of employees and the general public.

Position Details

Opening Date:01/23/2018
Functional Title:Examiner
Classification Title:Program Specialist II
Status:Internal/External Posting – TDI Employees and General Public
Application Deadline:Until Filled
Pay Group:B18
Monthly Salary: $3,400.00
Annual Salary:$40,800.00
Job Posting Number:18-136
Division:Financial Regulations/Examinations Section/MCQA Examinations
Location:333 Guadalupe Street, Austin, TX 78701
Travel Required:10 %

 

For more information, contact:

Last updated: 01/23/2018

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