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Texas Department of Insurance

The Texas Department of Insurance (TDI) is a state agency responsible for both consumers and the insurance industry. We work to fulfill our legislative mandate to regulate the insurance industry, administer the Texas workers’ compensation system, and promote a healthy insurance marketplace, while also protecting the people and the businesses that are served by insurance. We take our responsibility to Texans seriously and strive for excellent customer service through our professional attitude, competence and efficiency.

Important notice: Read before you apply

Veterans’ Preference:

To receive veterans’ preference, applicants must provide at least one the following documents with their State of Texas Application:

  • a copy of the DD 214, member #4;
  • a statement of compensation from the Veterans Benefits Administration; or
  • a copy of the DD 1300.

Applicable Military Occupational Specialty (MOS) codes are included, but not limited to the following: 56M, 68J, PS, 018, 0111, 4430, 3A1X1, 68, 3A

Additional Military Crosswalk information can be accessed at:

http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_ProgramManagement.pdf

Veterans: Go to www.texasskillstowork.com for assistance with translating your military work experience and training courses into civilian job terms, qualifications/requirements and skill sets.

Current Opportunity: Examiner

Amended (11/14/17)/Internal/External Posting – TDI Employees and General Public

The Examiner performs examinations of managed care entities; commercial exclusive provider benefit plans; and independent review organizations.


This position:

  • conducts a random review of complaint, claim, credentialing, and utilization review files to determine compliance with the Texas Insurance Code and Texas Administrative Code and other applicable statues;
  • reviews network adequacy, questionnaires, plan operations, and quality improvement documents for compliance with the Texas Insurance Code and Texas Administrative Code and other applicable statutes and rules;
  • prepares written reports using the applicable statutes and rules to compose clear and concise written correspondence regarding violations of insurance statutes and regulations;
  • prepares and recommends legal referrals to agency Compliance Intake Office;
  • meets with company management and representatives to discuss resolution of issues or problems relating to examination findings;
  • provides technical information in writing, in person, and over the telephone to company management and representatives;
  • updates internal policies, procedures and checklists for examination functions;
  • assists with review and analysis of proposed legislation and legislative implementation and revision of exam tools;
  • travels to participate in the on-site examination process with an overnight stay; and
  • assists with special projects.

Qualifications

Graduation from an accredited four-year college or university with a degree in accounting, finance, insurance, statistics, actuarial science, computer science, economics, or business administration.  Education and experience relevant to position may be substituted for one another on a year-for-year basis. 


Additionally, this position:

  • requires two years of experience in health care, regulatory, insurance, legal, or in a plan administration environment; and
  • prefers four years of experience in health insurance and health claim payments, and/or utilization review, and/or health complaints, and/or credentialing of health care providers.


This position requires demonstrated knowledge of:

  • Texas Insurance Code, Texas Administrative Code, and/or other applicable codes and statutes with regard to managed care;
  • business or program terminology, spelling, punctuation, grammar, typing formats, and word processing techniques and procedures; and
  • general office practices and administrative procedures.

This position requires demonstrated skill in:

  • organizing and prioritizing workload;
  • managing multiple competing priorities;
  • communicating technical information professionally and effectively, both verbally and in writing, with all levels of employees and the general public;
  • developing goals and objectives;
  • problem solving, decision making, and planning;
  • analyzing related data and using conclusions to reach resolution; and
  • using Microsoft Office software applications, including Word, Excel, and Outlook.

This position requires the demonstrated ability to:

  • apply critical thinking to comprehend complex regulatory rules and statutes to determine compliance or solve problems;
  • draft clear and concise reports of findings;
  • organize, prioritize, coordinate, and manage multiple tasks and special projects in order to meet established timelines;
  • take personal responsibility for completing assigned tasks;
  • make decisions based on sound reasoning;
  • understand and carry out complex instructions;
  • prepare and maintain complex records and files;
  • make decisions in accordance with rules, regulations, and procedures;
  • maintain the confidentiality of sensitive information;
  • offer positive and constructive ideas, encouragement and support to other staff members, while upholding the agency’s core values; and
  • establish and maintain an effective and harmonious working relationships with all levels of employees and the general public.

 

Position Details

Opening Date:08/14/2017
Functional Title:Examiner
Classification Title:Program Specialist II
Status:Amended (11/14/17)/Internal/External Posting – TDI Employees and General Public
Application Deadline:Until Filled
Pay Group:B18
Monthly Salary: $3,400.00
Annual Salary:$40,800.00
Job Posting Number:17-216
Division:Financial Regulation/Examinations Section/Quality of Care Examinations
Location:333 Guadalupe Street, Austin, TX 78701
Travel Required:10 %

 

For more information, contact:

Last updated: 11/22/2017

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