Quality Control Officer/ Ombudsman

Announcement Number: 1134927384

UNCLASSIFIED JOB ANNOUNCEMENT

Quality Control Officer/Ombudsman
Posted: April 19, 2024
Closing: May 15, 2024

Recruitment Open To:
This Public Employees' Benefits Program is seeking qualified applicants for the position of the
Quality Control Officer. This is an open competitive recruitment, open to all qualified applicants.
This is an unclassified position that serves at the pleasure of the Director of the Department of
Administration in accordance with NRS 287.0426.

Agency RESPONSIBILITIES:
The Public Employees' Benefits Program (PEBP) administers a self-funded group health and life
insurance program, which offers medical, prescription drug, dental, and basic life insurance
benefits. PEBP's insurance plans include a Consumer Driven Health Plan (CDHP), a Low
Deductible PPO Plan, a Premier EPO Plan, and a Health Maintenance Organization (HMO) plan.
PEBP also coordinates the transition of retirees with Medicare Parts A and B to an Individual
Medicare Exchange program.

PEBP is responsible for designing and managing a quality health care program for approximately
44,700 primary participants and 25,700 dependents totaling over 70,000 lives and includes
approximately 13,000 retirees on the Medicare Exchange Program. Participants include eligible
state employees and retirees, including eligible employees of the Nevada System of Higher
Education, as well as certain non-state local government employees and retirees, and certain
members of the Nevada Legislature. Dependents of the above-mentioned groups may also be
covered. The total enrollment in all PEBP plans is approximately 70,000 participants who reside in
and outside of the State of Nevada.

PEBP is governed by an eleven-member board. All members are appointed by the Governor.
For more information on PEBP visit the website at https://pebp.nv.gov

SALARY AND Benefits:
Annual Compensation for this position is $121,803 on the employer/employee paid retirement plan
or $104,328 on the employer paid retirement plan. The State of Nevada has an excellent benefit
package that includes a public employees' retirement plan, health, vision, dental, and life, 13 paid
CELESTENA GLOVER
Executive Officer
STATE OF NEVADA
PUBLIC EMPLOYEES' BENEFITS PROGRAM
3427 Goni Road, Suite 109, Carson City, Nevada 89706
Telephone 775-684-7000 | 702-486-3100 | 1-800-326-5496
https://pebp.nv.gov
JOE LOMBARDO
Governor
JACK ROBB
Board Chair holidays, and paid sick and annual leave. Other employee-paid benefits such as a deferred
compensation plan, flexible spending accounts, voluntary life, short-term disability,
auto/homeowners' insurance, pet insurance, and other voluntary product offerings are also available.

An explanation of the retirement options and information regarding state retirement benefits may be
accessed at www.nvpers.org. A description of the current health, vision, dental, and voluntary
benefits available to all employees may be accessed at https://pebp.nv.gov. Other optional benefits
are available, including a deferred compensation program.

Position Description:
Responsibilities include:
• Providing education and outreach to plan participants on how to navigate the PEBP plans
and benefits
• Working as an impartial and independent fact finder in reviewing and resolving appeals and
complaints
o Ensure all appeals and complaints filed with PEBP are thoroughly investigated and
responded to in a respectful, accurate and timely manner. All responses shall be in
accordance with PEBP's Master Plan Document and relevant sections of NRS
Chapter 287, NAC Chapter 287 and NRS Chapter 695G.
• Facilitate complaint resolution between PEBP, plan participants and vendors.
• Vendor Management - provides accurate, timely and consistent handling of issues to ensure
adherence to the terms of the applicable contract(s)
• Write/update plan documents and present recommended revisions to the PEBP Board for
approval.
• Serves as the agency's Privacy Officer

This position assists the Executive Officer with benefit plan management including oversight of the
administration of health insurance related benefits for 44,700 employees/retirees and 25,700
dependents including but not limited to PEBP self-funded medical, dental and vision plans, fully
insured HMO plans, life and voluntary services such as flexible spending accounts, short-term
disability and additional life insurance. The agency also acts as the advocate for the more than
13,000 retirees on the Medicare Exchange.

Knowledge, Skills, Abilities:
Knowledge and understanding of group health insurance (medical, prescription drug, dental and
vision), life insurance, long term disability insurance and wellness programs.

Knowledge and understanding of claims and benefits administration for medical, prescription drug,
dental and vision claims.

Knowledge and understanding of federal and State laws regarding healthcare and health insurance,
including the Health Insurance Portability and Accountability Act (HIPAA) and related privacy
rules; the Patient Protection and Affordable Care Act (ACA) and related coverage and reporting
requirements; the Public Health Services Act, which governs public sector health plans; and the
Nevada Revised Statutes regarding health insurance.
Ability to communicate difficult concepts orally and in writing to a variety of audiences.

Ability to write and interpret insurance Plan Documents and Summary Plan Descriptions.

To Qualify:
Bachelor's degree in business or healthcare related field, or equivalent education and experience as
an Ombudsman or Quality Control Officer in the healthcare or health insurance sector.
• Demonstrated effective communications skills (oral & written), including public speaking
experience
• Demonstrated successful staff supervision and staff development
• Demonstrated ability to work with and effectively interact with a wide variety of
constituencies (e.g., the PEBP Board, retirees, legislators, active employee groups, etc.).
• Ability to provide effective customer service, including discussing difficult/emotional topics
in sometimes confrontational settings
• Ability to read and understand documents such as contracts and governing benefit plan
documents

The best candidates will be knowledgeable about healthcare program administration, possess a
working knowledge of benefit plan management and have experience working with both employee
and retiree groups.

Persons offered employment in this position must submit to a pre-employment criminal
history check and fingerprint background investigation.

Position Location:
Carson City, Nevada

APPLICATION PROCESS:
Applications will be screened for minimum qualifications and experience. If there are fewer than
five (5) qualified applicants, all applicants will be invited to an interview.
Letters of interest and resumes will be accepted until May 15, 2024.
Applicants must submit a resume and a detailed letter of interest to Agency HR Services at the
following address:

Agency HR Services
agencyhr@admin.nv.gov
Attention: Monique Williamson
Fax: 725-214-9083

The State of Nevada is an equal opportunity employer dedicated to building diverse, inclusive, and innovative work
environments with employees who reflect our communities and enthusiastically serve them. All applicants are
considered without regard to race, color, national origin, religion or belief, age, disability, sex, sexual orientation,
gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation
and/or wages.

Closing Date/Time: 5/15/24

Carson City, Nevada United States View Map