Responsible for regulatory oversight of health and disability carriers to assure quality and legal compliance of healthcare products sold in the marketplace. Analyzed insurance practices, contracts, and rules to assure compliance with public policy and Washington law; evaluated administrative law as applied to individual cases; suggesting changes when applicable. Protected and educated health and disability carriers in the areas of state and federal regulations. Recommended corrective enforcement action or advised insurance industry professionals and/or the public based upon results of analysis. Maintain paper and paperless records of all clients, contracts, communications, investigations and reports involving assigned medical, dental and disability carriers utilizing agency and federal database. Participate in meetings with carriers, legal advisors, Deputy Commissioner and other regulatory staff to discuss and resolve enforcement and implementation issues.

Presiding officer for Basic Health appeals related to eligibility, suspension, disenrollment and recertification. Agency representative at hearings before the Office of Administrative Hearings; program representative at agency administrative hearings. Mediated dispute resolution between contracted health plans and enrollees. Conducted investigations of fraud/intentional misrepresentation. Audit enrollee records of financial sponsors (statewide) off site. Monitored quality/compliance of dispute outcomes between health plans and members. Managed and participated in projects, strategic planning (creating efficiencies/streamline process, cost savings, and reduction of appeals). Assisted Manager as Governor/Legislative liaison for Basic Health program. Developed, communicated and implemented appeals-related training for managers, supervisors and direct services staff. Developed Basic Health program communication materials and language for policy/procedures, member handbook, letters, and training packets. Complaint/appeal/hearing data collection, analysis, and reporting. Maintained database for appeals/hearings.Representing the Public Employees Benefits Board (PEBB) program, level 1 decision-maker for medical/dental issues related to eligibility, life, long term disability, claims, and benefits. Appeals Coordinator for Basic Health Appeals Committee. Agency representative at hearings before the Office of Administrative Hearings; program representative at agency administrative hearings. Monitor quality and contractual compliance of dispute outcomes between health plans and members for Basic Health program. Participate in projects, strategic planning (creating efficiencies/streamline process, cost savings, and reduction of appeals). Hire, train, supervise, and direct activities of support staff.Governor/Legislative liaison for the agency. Develop agency communication materials and language for policy/procedures, member handbook, and training manuals.

Plan, organize and implement diverse outreach strategies to publicize and promote the Basic Health program for the uninsured. Manage Customer Service Department for the agency. Hire, train, manage and direct activities of customer service department. Develop marketing outreach materials (brochures, news/radio advertisements). Produce monthly newsletter with upcoming events, wellness activities, and draft featured articles. Conduct presentations/training for community service organizations. Appeals Coordinator for Health Care Authority Appeals Committee. Conduct investigations and develop cases for presentation to Appeals Committee. Maintain and preserve integrity of collected evidence to ensure proper handling of a case. Determine eligibility for Basic Health Plan program based upon written application information and telephonic interviews with applicants. Monitor quality and contractual compliance of dispute outcomes between health plans and members. Rules Coordinator (coordinate WAC filings, attend public hearings). Assist in development of budget projections. Governor/Legislative liaison for the agency. Develop Basic Health Program communication materials and language for policy/procedures, member handbook, letters, and training manuals.