Life and Health Complaints Analyst

Under general supervision, the Life and Health Complaints Analyst is responsible for reviewing inquiries for compliance with applicable laws in determining eligibility for complaints.  This role provides professional level support directly to the Consumer Services department.

Evaluates inquiries directed against insurers concerning unfair insurance trade practices as defined by Georgia law by reviewing laws enacted against such practices to determine a basis for action on such complaints.

Analyzes insurance policies of complainants by evaluating and interpreting the contract to determine the extent of coverage, the exclusions specified, and the conditions affecting the payment of claims.

Analyzes facts by reviewing and evaluating the incidents related to claims to determine whether policy coverage extends to such incidents.

Requests the claims and underwriting files of insurers for review to determine "good faith" investigations of claims and to determine if they have met the obligations set forth in the policy.

Analyzes the evidence by reviewing and evaluating the reasons for the claims' rejection to determine the basis.

Recommends payment within reasonable time by citing sections of the Georgia Code or policy provisions that pertain to the insurer's obligation if it is decided that the insurer is liable.

Conducts research to compile information needed to generate reports, complete projects, and accurately respond to questions and concerns.

Performs other duties an assigned.