Insurance Complaints Specialist

Division:Life & Health Office Location:900 Pennsylvania Avenue, Charleston, WV 25302 ***This job opportunity is not in the classified service and is not covered by the West Virginia Division of Personnel merit system***The Life & Health division of the WV Offices of the Insurance Commissioner helps oversee state-level efforts to implement federal health care reform and assists in the development of health-related initiatives.The ideal candidate will be responsible for performing the following duties: The selected candidate will act as a liaison between consumers, providers, insurance companies, and various stakeholders. Review and analyze consumer complaints to determine if insurance companies are following policy language and state laws, as well as review medical records, identify violations of regulations, and escalate complex cases to senior staff or legal counsel for further action. Under limited supervision, the selected candidate will answer phone calls and meet with walk-in consumers to determine the level of investigation required and will maintain thorough documentation of every call and complaint investigation through a cloud-based system. Will perform other duties as assigned.The following knowledge, skills, and abilities will be beneficial to the selected candidate: The ideal candidate will have excellent communication, problem-solving and organizational skills, a high level of emotional intelligence, and the ability to be adaptable, as he or she must serve as a mediator between parties to bring complaints to resolution. Click The APPLY Link To Apply Online .