TDI-Compliance Analyst I

Company:  Texas Department of Insurance
Location: Austin
Closing Date: 02/11/2024
Hours: Full Time
Type: Permanent
Job Requirements / Description

Please paste the following URL into a browser to view the entire job posting in the CAPPS Career Section: You may apply to the job directly through the CAPPS Career Section. It is not necessary to apply both through Work In Texas and CAPPS Career SectionDo you have a passion for public service and enjoy making a difference? Dont miss out on this opportunity. The Texas Department of Insurance (TDI) is hiring! Apply now if youre looking for a rewarding career in public service. We regulate the insurance industry, administer the Texas workers compensation system, and educate and protect consumers. Youll love the benefits of working at TDI: Flexible work schedules. Hybrid work schedule, if applicable. Work-life-balance. 96 hours of accrued vacation a year. 96 hours of accrued sick leave a year. 20+ holidays every year. Career advancement opportunities. Free parking. Free comprehensive medical insurance for full-time employees and 50% off premium costs for dependents (state pays the other 50%). Working at TDI offers many benefits. TDI is a qualifying organization for the Federal Public Service Loan Forgiveness Program. TDI also offers a lifetime monthly retirement annuity as well as 401(k) and 457 Programs under the Employees Retirement System of Texas. TDI is located at the Barbara Jordan Building at 1601 Congress Ave in Austin. The innovative structure is part of the states Capitol Complex project. Before you apply: Learn about our selection process, our military employment preference, and licensing and credential requirements. Compliance Analyst I (Form Filing/Network Adequacy Reviewer) This position performs entry-level to routine (journey-level) technical insurance work on the Form Filings, WCNet, Network Adequacy Review Program in the Managed Care Quality Assurance (MCQA) Office of the Life and Health Division. Work involves examining, evaluating, and monitoring records, programs, policies, documents, and/or contracts to ensure conformity with laws, rules, and regulations; and conducting inspection and analysis activities. Works under moderate supervision with limited latitude for the use of initiative and independent judgment. This position: Reviews Workers Compensation (WC) Network applications; Health Maintenance Organization (HMO) form filings, including COA applications and service area expansions; HMO, Preferred Provider Benefit Plan, and Exclusive Provider Benefit Plan network adequacy reports, waiver requests, and access plans, for completeness; verifies compliance with laws and regulations; identifies issues regarding compliance with laws and regulations that require follow-up; communicates information to companies about incomplete or incorrect filings, or areas of concern. Enters data for HMO form filings into the filings tracking system and related databases to maintain a current status of each filing. Responds to inquiries from internal and external customers by performing queries, researching information, and preparing correspondence and related documents; composes clear and concise written correspondence regarding violations of insurance statutes and regulations. Attends meetings with regulated entities, other governmental agencies, and agency staff, and provides management and other staff with comments relating to technical managed care insurance topics and other issues. Assists in making referrals to TDI Enforcement for possible disciplinary action for Texas Insurance Code and Texas Administrative Code violations. May assist in routine internal compliance auditing. May assist in assessing the impact of existing and proposed legislation or policies on agency programs regarding managed care and may provide input on rules and proposed legislation. Cross-trains in Utilization Review Agent (URA) and/or Independent Review Organization (IRO) new applications and/or renewals Utilization Review Agent (URA) and/or Independe t Review Organization (IRO) new applications and/or renewals for completeness; verifies compliance with laws and regulations; identifies issues regarding compliance with laws and regulations that require follow-up; communicates information to companies about incomplete or incorrect filings or areas of concern. Participates in cross-training in multiple functions within the MCQA Office. Performs other duties as assigned. Qualifications: This position requires: Sixty college hours. One year of experience in a health care, regulatory, insurance, legal, plan administration environment, or in a field relative to assignment. Education and experience relevant to position may be substituted for one another on a year-for-year basis. Additional job details: This position requires regular work attendance. The position may be eligible for a hybrid work schedule. If eligible, the employee must have a secure, dedicated workspace with reliable broadband internet service. The ideal candidate must be available for weekly meetings and group collaboration via Microsoft Teams and other applications during regular business hours. The interview will include a skills test. Preferences for this position include: Familiarity with regulations and investigation of managed care delivery process. This position requires demonstrated knowledge of: State laws, rules, procedures, and regulations relevant to job requirements. Insurance principles and practices. This position requires demonstrated skill in: Problem solving and critical thinking. Using Microsoft Office software applications, including Word, Excel, Outlook, and SharePoint. Using personal computers sufficient to enter and extract data from related systems and programs such as Centralized Accounting Payroll and Personnel (CAPPS) and other systems required to perform the job. This position requires the demonstrated ability to: Communicate and work effectively with a wide range of people with varied skills, knowledge, and backgrounds. Maintain the confidentiality of sensitive information. Analyze and solve work-related problems and work independently on a variety of administrative work and technical assignments. Manage and coordinate multiple tasks and priorities to meet necessary deadlines. Work both independently and as a team player. Select and accurately transcribe data from several source documents. Perform a series of procedural steps. Apply critical and analytical thinking skills. Research and interpret rules, regulations, filing requirements, policies, and procedures. Comprehend and apply complex regulatory rules and statutes to determine compliance or solve problems. Veterans Get help translating your military work experience and training courses into civilian job terms, qualifications/requirements, and skill sets. Redact personal or sensitive information from all attachments. To receive a veterans preference, you must submit the following documents, as applicable, with your application. Copy of the DD-214; member #4. Statement of compensation from the Veterans Administration or Copy of the DD1300. Applicable Military Occupational Specialty (MOS) codes are included, but not limited to one of the following: No direct military equivalent. Click or copy and paste the following link into your browser to access Military Crosswalk information:

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