Program Officer

Position: PROGRAM OFFICER 1
The Silver State Health Insurance Exchange, with the duty station located in Carson City, is seeking a Program Officer I to serve as the Consumer Assistance Support Specialist, providing support to consumers, carriers, and brokers, and acting as a subject matter expert working directly with the contracted consumer assistance call center. Under the administrative direction of the Quality Assurance Manager, this position administers all Consumer Assistance Support functions, including the development and implementation of policies and procedures for the Consumer Assistance Support section of the Exchange.

The Specialist interprets and communicates complex program rules and regulations to call center and Exchange staff, and makes determinations on complex, escalated complaints or disputes involving enrollment partners, insurance carriers, and consumers. This role also provides subject matter expertise, training, and technical assistance to the consumer assistance call center to resolve escalated issues that cannot be addressed at the first or second levels of dispute resolution.

Responsibilities include planning and developing processes, carrying out programmatic duties by interpreting and applying broadly stated policies, procedures, and insurance rules, and overseeing the creation, revision, and implementation of procedural manuals to ensure call center staff, Exchange staff, and the public clearly understand and comply with requirements related to enrollment in insurance products offered through the Exchange.

Program Officers administer a program or major component of a program by planning, coordinating and managing services and activities in accordance with legal and regulatory requirements and established program performance standards and objectives. Incumbents make decisions that significantly impact program direction and participants or clients and must determine the process required to achieve results within resource constraints.

Bachelor's degree from an accredited college or university in business or public administration, or other discipline related to the program assignment; OR graduation from high school or equivalent education and two years of para-professional program support experience equivalent to an Administrative Assistant III in Nevada State service which required the application of State and/or federal laws, policy and procedures; reviewing documents prepared by others for program compliance determinations;

or preparing reports which summarize financial and statistical information; OR an equivalent combination of education and experience as described above.

Recommend, interpret, implement and disseminate regulations, policies and procedures related to program operations; and review amendments to applicable laws and regulations and incoming policy or procedural information for interpretation and distribution.

Research, develop, recommend and implement long term plans to enhance and maximize services provided; evaluate the success of the program and adapt to changes in funding, eligibility requirements and production/processing elements of the program.

Provide specialized information and services and serve as the technical expert regarding the assigned program services, activities and requirements; provide information, either verbally or in writing, to other State and federal agencies, management, department staff, program participants and the general public to ensure understanding and compliance; explain and apply laws, regulations, policies and procedures, and resolve high-level customer service issues and complaints;

may develop and conduct presentations before State and federal agencies, management, program participants and/or other stakeholders as required.

Monitor program activities through on-site visits and/or the review of reports and records to ensure compliance with federal and/or State laws; evaluate and recommend changes to provider eligibility, client needs, vendor requirements, or identify client abuse or fraud; identify and project demographic and economic trends; conduct studies related to assigned program area; evaluate information and prepare reports…