State of Hawai'i
TEMPORARY DISABILITY INSURANCE (TDI) /HEALTH CARE SPECIALIST V (IV, III, II) (SR
State of Hawai'i, Houston, Texas, United States,
Temporary Disability Insurance/Health Care Specialist V:
Supervises the operations of a program for claims examination and the statewide review and approval of plans for the Temporary Disability Insurance and Pre-paid Health Care programs of the State; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist IV:
Performs the most difficult and complex health care plans review and acceptance activities as a regular assignment; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist III:
Reviews and recommends the approval or disapproval of plans and TDI provisions of collective bargaining agreements submitted by insurance carriers and employers to meet requirements of the TDI and Health Care laws, rules and regulations of the State; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist II:
Performs the full range of Temporary Disability Insurance (TDI) claims examination and denial of benefits review; assists and participates in the review of TDI and Health Care plans; receives advanced training; and performs other duties as required.TO QUALIFY, YOU MUST MEET ALL OF THE FOLLOWING REQUIREMENTS:Education:
Applicants must have graduated from an accredited four (4) year college or university with a bachelor's degree.Excess work experience as described under Specialized Experience, or any other responsible administrative, professional, or other analytical work experience which would provide knowledge, skills and abilities comparable to those acquired in four (4) years of successful study while completing a college or university curriculum leading to a baccalaureate degree may be substituted for education on a year-for-year basis. To be acceptable, the experience must have been of such scope, level and quality as to assure the possession of comparable knowledge, skills and abilities.The education or experience background must also demonstrate the ability to write clear and comprehensive reports and other documents; read and interpret complex written material; and solve complex problems logically and systematically.General Experience:
One-half (1/2) year of progressively responsible professional or other analytical work in claims examination which involved fact-finding, analysis and evaluation to determine eligibility and/or compensability; the interpretation and application of relevant laws, rules and regulations; and dealing effectively with individuals to elicit information orally and in writing.Specialized Experience:Level V: Three (3) years of specialized experience is required.Level IV: Two (2) years of specialized experience is required.Level III: One (1) year of specialized experience is required.Level II: No specialized experience is required.Specialized Experience: Knowledge and application of the Temporary Disability Insurance and/or Pre-paid Health Care laws, rules and regulations, which involved analyzing, explaining, applying and interpreting those laws, rules and regulations, and pertinent rulings, precedents, and related criteria.Examples of acceptable specialized work experience include but are not limited to:Examining and approving or disapproving claims for government-mandated benefits and developing or reviewing employers’ plans which may include self-developed plans and/or collective bargaining agreements providing such benefits; and/or • Reviewing or developing health care plans concerned with ensuring their conformance with statutory requirements, as a regular work assignment; and/or the enforcement of both state and/or federal regulatory laws.Reviewing complex documentation for accuracy and completeness and which demonstrates the ability to understand and apply state and/or federal regulatory laws.
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Supervises the operations of a program for claims examination and the statewide review and approval of plans for the Temporary Disability Insurance and Pre-paid Health Care programs of the State; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist IV:
Performs the most difficult and complex health care plans review and acceptance activities as a regular assignment; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist III:
Reviews and recommends the approval or disapproval of plans and TDI provisions of collective bargaining agreements submitted by insurance carriers and employers to meet requirements of the TDI and Health Care laws, rules and regulations of the State; and performs other duties as required.Temporary Disability Insurance/Health Care Specialist II:
Performs the full range of Temporary Disability Insurance (TDI) claims examination and denial of benefits review; assists and participates in the review of TDI and Health Care plans; receives advanced training; and performs other duties as required.TO QUALIFY, YOU MUST MEET ALL OF THE FOLLOWING REQUIREMENTS:Education:
Applicants must have graduated from an accredited four (4) year college or university with a bachelor's degree.Excess work experience as described under Specialized Experience, or any other responsible administrative, professional, or other analytical work experience which would provide knowledge, skills and abilities comparable to those acquired in four (4) years of successful study while completing a college or university curriculum leading to a baccalaureate degree may be substituted for education on a year-for-year basis. To be acceptable, the experience must have been of such scope, level and quality as to assure the possession of comparable knowledge, skills and abilities.The education or experience background must also demonstrate the ability to write clear and comprehensive reports and other documents; read and interpret complex written material; and solve complex problems logically and systematically.General Experience:
One-half (1/2) year of progressively responsible professional or other analytical work in claims examination which involved fact-finding, analysis and evaluation to determine eligibility and/or compensability; the interpretation and application of relevant laws, rules and regulations; and dealing effectively with individuals to elicit information orally and in writing.Specialized Experience:Level V: Three (3) years of specialized experience is required.Level IV: Two (2) years of specialized experience is required.Level III: One (1) year of specialized experience is required.Level II: No specialized experience is required.Specialized Experience: Knowledge and application of the Temporary Disability Insurance and/or Pre-paid Health Care laws, rules and regulations, which involved analyzing, explaining, applying and interpreting those laws, rules and regulations, and pertinent rulings, precedents, and related criteria.Examples of acceptable specialized work experience include but are not limited to:Examining and approving or disapproving claims for government-mandated benefits and developing or reviewing employers’ plans which may include self-developed plans and/or collective bargaining agreements providing such benefits; and/or • Reviewing or developing health care plans concerned with ensuring their conformance with statutory requirements, as a regular work assignment; and/or the enforcement of both state and/or federal regulatory laws.Reviewing complex documentation for accuracy and completeness and which demonstrates the ability to understand and apply state and/or federal regulatory laws.
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