Claims Review Specialist II

Job Posting Title

Claims Review Specialist II

385 OKLAHOMA INSURANCE DEPARTMENT

Insurance Department

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Continuous if Blank

Full time

Regular

Salary $62,762.84

Under limited supervision, analyze and investigate Property and Casualty, and Life and Health consumer complaints and inquiries received by the Consumer Assistance/Claims Division of the Oklahoma Insurance Department.

• Conduct interviews with walk-in claimants to gather information and answer questions in an effort to assist claimant with filing a request for assistance. Explain process and procedures of consumer assistance division.
• Answer questions pertaining to the information submitted via feedback.
• Any other duties deemed necessary by the supervisor, including meetings, conferences, state of emergency issues, and outreach events and any necessary travel.
• Serve as intermediary for the inquirer and provide direct contact with the insurer.
• Plan, organize and implement a course of action for each consumer inquiry to provide the most efficient, prompt, and effective response within the jurisdiction of the department. Maintain effective communication with the consumer throughout the process.
• Convey response to the consumer or explain and facilitate the understanding of a response that may not be desirable.
• Provide technical knowledge, expertise, detailed information, and response to the public regarding various insurance questions and concerns.
• Responsible for answering phone calls from the public regarding insurance questions on policies, procedures, and statutes.
• Backup to the Claims Processor Reviewer.
• Perform other duties as required.

• Be knowledgeable of both Property and Casualty and Life and Health insurance lines.
• Be knowledgeable of insurance laws, rules, and policies.
• Possess skill in time management and decision-making.
• Initiate, implement and complete required tasks to resolve all insurance questions, concerns, or complaints.
• Exercise judgment in reviewing claim files; handle confidential work with tact and discretion.
• Maintain effective working relationships.
• Communicate effectively.

Level II
- Bachelor’s degree or equivalent education and experience. Experience in the insurance field with account management or customer assistance, demonstrating evidence of knowledge and skills to perform the tasks of the job. Industry designation related to consumer assistance, CISR, considered a plus.

The selected applicant must pass a background check. Individuals may be required to pursue NAIC designations as job duties require. Upon hire, any applicant who is licensed as a producer/agent, adjuster or is otherwise affiliated with any entity that is regulated by the department must surrender their license and terminate any financial or non-financial affiliation with the entity that is regulated by the department.

This position may be eligible for telework under OID’s Telework Program after initial training.

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.