Insurance Investigator

The Maryland Insurance Administration (MIA) is an independent State agency that regulates Maryland’s insurance industry and protects consumers by monitoring and enforcing insurers’ and insurance professionals’ compliance with State law.  Through the diligence of a highly professional staff of financial analysts, accountants, lawyers, law enforcement officers, actuaries, and others, the MIA works to facilitate a strong insurance marketplace where consumers are well informed and treated fairly.  Staff members are subject matter experts who serve as a resource for lawmakers, consumers, and other public and private entities. 

MIA is charged with a range of responsibilities including the licensure of insurance companies and insurance producers (brokers/agents) operating in Maryland, the conduct of financial examinations of companies to monitor financial solvency, and the review and approval of rates and contract forms. MIA investigates reports of consumer fraud and consumer complaints about life, health, automobile, homeowners, and/or property insurance.  Insurance companies are subject to market conduct examinations and other actions to monitor compliance with Maryland law.  MIA has a unit dedicated to consumer education and outreach, which participates in hundreds of events and reaches thousands of individual consumers annually.

This position will investigate consumer complaints filed by members covered by a health benefit plan against the insurance carrier.  The incumbent will respond to written and verbal complaints and inquiries from citizens, attorneys, insurers, producers and other entities; and respond to emergency calls received from members, medical providers on behalf of members, and members' representatives regarding carrier denials based on medical necessity or medical appropriateness of care.  The position will analyze responses received from carriers and perform further investigation when necessary; apply laws and regulations to the facts of a case to determine the appropriate conclusion; and prepare summaries of cases to provide a chronology of events and related exhibits.  The incumbent will determine if a carrier has violated Maryland Insurance Law in handling an appeals and grievance complaint and recommend appropriate administrative penalties when a carrier is found to have violated the law. 

This position is required, at scheduled times, to be "on-call" during non-working hours to include evenings, weekends and holidays as necessary.

Education: Bachelor’s degree from an accredited college or university.

Note: Two years of experience in the review of medical records or medical claims can be substituted for the required education.

STATE OF MARYLAND BENEFITS

For immediate consideration, you MUST upload one file (WORD or PDF) at the "Resume" tab that contains:

1. a cover letter stating your interest and salary requirements; and
2. a current professional resume.

If you are unable to apply online, you may submit the requested information via mail.  Please include all items listed above to ensure consideration.  Incomplete submissions will not be considered.

Complete application packets may be mailed to:

Maryland Insurance Administration Human Resources - Recruitment#: 14-009639-005
200 St. Paul Place, Suite 2700
Baltimore, MD 21202

TTY  Users: call via Maryland Relay

We thank our Veterans for their service to our country, and encourage them to apply.

As an equal opportunity employer Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.