Marketplace Appeals & Compliance Analyst
Marketplace Appeals & Compliance Analyst
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1 Vacancy
Job Description
Job Requisition ID:48069
Closing Date: 07/08/2025
Agency:Department of Insurance
Class Title:EXECUTIVE I - 13851
Skill Option:None
Bilingual Option:None
Salary: $5928 - $8493 (Anticipated starting salary starting 7/1/25 $5928/CBA Language applies)
Job Type: Salaried
Category:Full Time
County: Cook
Number of Vacancies: 2
Bargaining Unit Code:RC062
Merit Comp Code:
This position is a union position; therefore provisions of the relevant collective bargaining agreement/labor contract apply to the filling of this position.
All applicants who want to be considered for this position MUST apply electronically through the website. State of Illinois employees should click the link near the top left to apply through the SuccessFactors employee career portal.
Applications submitted via email or any paper manner (mail fax hand delivery) will not be considered.
*Answer all application questions thoroughly. DO NOT STATE SEE RESUME.*
Position Overview
The Marketplace Appeals Analyst represents Get Covered Illinois in Marketplace appeals which include advanced level and complex analysis and problem-solving in the application and administration of healthcare programs within the Affordable Care Act. The position requires an advanced and integrated knowledge and competencies on the appeals regulatory and legal processes and requirements. The Marketplace Appeals Analyst working in a high volume and data/deadline-driven environment researches analyzes and identifies the appropriate and relevant factors affecting program eligibility both current and historical in order to resolve complex issues. The problem-solving aspects of the position require complex legal analysis and frequently entail applying agency policy and federal and state law to novel factual situations each case being highly variable.
Get Covered Illinois is the State of Illinoiss new Health Insurance Marketplace. Get Covered Illinoiss mission is to increase access enrollment affordability and choice for individuals and families by connecting them to health insurance plans and savings available through the Affordable Care Act. Get Covered Illinois provides pathways to coverage through a consumer-centric online application platform a Customer Assistance Center localized outreach and education strategies and a network of in-person assisters embedded in communities across the state that help Illinoisans enroll in the coverage that best meets their families needs. Get Covered Illinois is part of the Illinois Department of Insurance and has offices in Chicago and Springfield.
Why Work for Illinois
Working with the State of Illinois is a testament to the values of compassion equity and dedication that define our state. Whether youre helping to improve schools protect our natural resources or support families in need youre part of something biggersomething that touches the lives of every person who calls Illinois home.
No matter what state career youre looking for we offer jobs that fit your life and your scheduleflexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.
Essential Functions
As a State-Based Marketplace Appeals Analyst assists with appeals or Resolution Review operations and independently processes appeals or Resolution Review cases and duties related to such.
Provides technical expertise for the appeals or Resolution Review operations for the Marketplace.
Performs detailed case research and analysis related to appeals and Resolution Review requests and determines eligibility for certain Illinois health care programs.
Provides general compliance monitoring and audit support and assists with data coordination and privacy/security collaboration.
Assists with training and staff developments to ensure compliance standards and needs are met.
Serves as liaison between GCIs Compliance and Program Oversight team and the Department of Insurances (DOI) Legal team.
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.
Minimum Qualifications
Requires knowledge skill and mental development equivalent to completion of four (4) years of college preferably with coursework in business or public administration.
Requires one (1) year of responsible administrative experience in a public or business organization or completion of an agency approved professional management training program.
Preferred Qualifications
Prefers one (1) year of experience dealing with administrative appeals processes.
Prefers one (1) year of experience drafting and/or implementing compliance policies procedures or monitoring tools in a healthcare or public sector setting.
Prefers at least two (2) years of experience with Marketplace eligibility in regard to appeals or compliance.
Prefers at least two (2) years of experience with Medicaid or other government healthcare programs.
Prefers at least two (2) years of experience attending or supporting administrative hearings including preparing documentation submitting evidence and providing testimony on behalf of an agency or organization when necessary.
Prefers at least two (2) years of experience with designing and/or implementing a compliance program in a healthcare or government setting.
Prefers at least two (2) years of experience with general compliance monitoring activities such as policy compliance checks and corrective action planning.
Prefers at least two (2) years of experience demonstrating good oral and written communication skills to express ideas clearly concisely and courteously across multiple audiences including the public and internal stakeholders.
Prefers at least two (2) years of experience coordinating with multiple internal and external stakeholders (e.g. state and federal agencies IT vendors) on compliance and appeals related activities.
Prefers at least two (2) years of experience tracking and analyzing appeals trends and recommending improvements to appeals processes using performance metrics or internal dashboards.
Specialized Skills
Requires one (1) year of experience dealing with administrative appeals processes.
Requires one (1) year of experience drafting and/or implementing compliance policies procedures or monitoring tools in a healthcare or public sector setting.
Conditions of Employment
Requires the ability to pass a background check.
Requires ability to travel in the performance of duties with overnight stays as appropriate.
The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description.
Certain provisions of the revolving door restrictions contained in 5 ILCS 430/5-45 apply to this position. As a result the employee should be aware that if offered non-State employment during state employment or within one year immediately after ending State employment the employee shall prior to accepting any such non-State employment offer notify the Office of the Executive Inspector General for the Agencies of the Illinois Governor (OEIG) or may be subject to a fine.
About the Agency
The Department of Insurance (DOI) regulates the insurance market in the State of Illinois including but not limited to licensing and educating insurance agents investigating Workers Compensation fraud and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency. DOI has approximately 220 employees who are split between our Chicago and Springfield offices.
State of Illinois employees enjoy a robust benefit package including:
- Health Life Vision and Dental Insurance
- 13 Paid Holidays annually 14 on even numbered years
- 10-25 days of Paid Vacation time annually - (10 days in year one of employment)
- 12 Paid Sick Days annually (sick days carry over from year to year)
- 12Weeks Paid Maternity/Paternity Leave
- 3 Paid Personal Days annually
- Pension Plan
- Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
- Flexible work schedules may be available dependent upon position
- Tuition Reimbursement Program and Federal Public Service Loan Forgiveness Program eligibility
Work Hours: M-F; 8:30am - 5:00pm(Requires the ability to report to the work location during work hours)
Work Location:115 S. LaSalle Street 13th Floor Chicago IL 60603
Agency ContactEmail:
Posting Group: Legal Audit & Compliance
This position DOES contain Specialized Skills (as that term is used in CBAs).
APPLICATION INSTRUCTIONS
Use the Apply button at the top right or bottom right of this posting to begin the application process.
If you are not already signed in you will be prompted to do so.
State employees should sign in to the career portal for State of Illinois employees a link is available at the top left of the homepage in the blue ribbon.
Non-State employees should log in on the using the View Profile link in the top right of the homepage in the blue ribbon. If you have never before signed in you will be prompted to create an account.
If you have questions about how to apply please see the following resources:
State employees: Log in to the career portal for State employees and review the Internal Candidate Application Job Aid
Non-State employees: on click Application Procedures in the footer of every page of the website.
The main form of communication will be through email. Please check your junk mail spam or other folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:
Required Experience:
IC
Employment Type
Full-Time
