TDI-Compliance Analyst I

Do you have a passion for public state service and enjoy making a difference?  Don’t miss out on this opportunity. The Texas Department of Insurance (TDI) is hiring! Apply today if you’re looking for a rewarding career in public state service. TDI regulates the insurance industry, administers the Texas workers’ compensation system, educates, and protects consumers. TDI is located at the Barbara Jordan Building at 1601 Congress Avenue in Austin, near the Texas Capitol.

Benefits Of Working At Tdi:

·         Flexible work schedules.

·         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.

• 401(k) and 457 Programs.
• State of Texas retirement plan with a lifetime annuity through the Employee Retirement System of Texas (ERS).
• Free comprehensive medical insurance for full-time employees and 50% off premium costs for dependents (state pays other 50%).
• Optional benefits like dental, vision, life insurance, and many more.
• Qualified employer for the Federal Public Service Loan Forgiveness Program.
• 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.

Before You Apply:

Learn about our selection process, our military employment preference, 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 Independent 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.
• 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.
• Regular work attendance.
• The interview will include a writing test.
• Familiarity with regulations and investigation of managed care delivery process.

This Position Requires:

Additional Job Details:

Preferences For This Position Include:

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.

Military Employment Preference

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 military employment preference, you must submit the following documents, as applicable, with your application. See How to Apply – Military Employment Preference.

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:

https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_ComplianceInspectionandInvestigation.pdf

How To Apply:

All applications must contain complete job histories, including job title, dates of employment, name of employer, manager’s name and phone number, and a description of duties performed. We may reject applications that do not include all the required information. Resumes do not substitute for this required information.

Submitted Through Work In Texas:

Work in Texas (WIT) applicants must complete supplemental questions to be considered for the position. To complete supplemental questions, go to CAPPS Career Center to register or log in and access your profile.