Insurance Consumer Advocate 2025-01115
Insurance Consumer Advocate 2025-01115
Posted on :
27-04-2025
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1 Vacancy
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Job Description
Description and Functions
Open Until FilledGENERAL DESCRIPTION:
Acts primarily as a consumer advocate in resolving problems and consumer complaints with insurance companies doing business in Wyoming in the lines of health insurance life insurance and annuities. Assists in the regulation of insurance in protecting the Wyoming consumer from unfair trade practices and improper claim settlements.ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed in the job level.- Provides technical advice and assistance to Wyoming consumers regarding state insurance statutes and regulations and acts as a liaison for complaints with federal agencies.
- Represents the agency fairly and impartially in the advice to consumers agents and insurance companies in the resolution of complaints involving disputes such as billing discrepancies nonrenewals cancellations and claims settlements etc.
- Confers with clients advises them regarding their complaints and facilitates the settlement of claims and insurance issues between the consumer agents and insurance companies.
- Receives and investigates complaints made by individuals to the agency.
- Resolves consumer complaints through verbal and detailed written communications.
- Makes recommendations negotiates and attempts to resolve disputes before being referred to an administrative hearing.
- Interprets complex insurance contracts stays current with insurance issues and case studies involving opinions with regard to health insurance life insurance and annuities
- Opens and maintains consumer complaint files.
- Refers identified conduct of unfair and deceptive trade practices and claims settlement violations for administrative action.
- Coordinates investigations due to allegations of fraud.
- Acts as a consultant with clients interdepartmental units and outside sources.
- Implements agency policies and procedures for coordinating referrals and conducting investigations.
- Completes report requirements on cases or individuals; may provide continuing education classes to individuals.
- Responsible for the initiation investigation and closure of inquiry and complaint files from insurance consumers regarding producers brokers and thirdparty administrators.
- Assists with market conduct examination of insurance companies and coordinates with other state regulatory agencies.
Qualifications
PREFERENCES:
Preference may be given to applicants who have knowledge and work experience in the insurance industry or insurance regulation.
KNOWLEDGE:
- Knowledge of complex language in health insurance annuities and life insurance policies and coverage and their interpretations.
- Knowledge of insurance terms concepts products principles and common industry practices.
- Knowledge of Wyoming insurance statutes and regulations.
- Knowledge of other related Wyoming statutes that overlap with the insurance code and claims processing.
- Knowledge of federal law and requirements related to individual and group insurance.
- Knowledge of the federal marketplace large and small group insurance Medicare
limited indemnity plans shortterm limited duration plans healthcare sharing
ministries MEWAs prescription drug plans and all elements of health insurance. - Ability to identify problems utilize negotiation techniques develop solutions and implement resolutions.
- Ability to sympathize listen and work with Wyoming consumers. Excellent customer
service skills. - Ability to think critically and problem solve.
- Knowledge or experience with databases or record management systems.
- Knowledge of HIPAA record management and experience with confidentiality.
- Ability to communicate clearly effectively and professionally in writing and verbally with internal staff the public and insurance company representatives.
MINIMUM QUALIFICATIONS:Education:Bachelors Degree (typically in Business)Experience:01 year of progressive work experience (typically in Business)OREducation & ExperienceSubstitution:34 years of progressive work experience (typically in Business)Certificates Licenses Registrations:NoneNecessary Special Requirements
PHYSICAL WORKING CONDITIONS:- Work performed in an office setting.
- Travel may be required to attend various state and national conferences.
- Travel may be required within the state of Wyoming to assist consumers.
NOTES:- FLSA: NonExempt
Supplemental Information
044Department ofInsurance
Clickhere to view the State of Wyoming Classification and Pay Structure.
URL: State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.
Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.
Employment Type
Full-Time
Key Skills
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