Complaint Analyst (Analyst II)

Job Description and Duties This recruitment has been posted for more vacancies than currently exist as it may be used to fill additional identical vacancies which may occur within 180 days of the closing date of this bulletin. The DMHC Help Center educates members about their health care rights and resolves complaints against health plans to ensure a stable and accessible health care delivery system. Under the direction of the Supervisor I, the Analyst II is assigned the more complex program-related responsibilities using the interpretation and implementation of the Knox-Keene Health Care Service Plan Act of 1975 (KKA), Title 28 of the California Code of Regulations (CCR), consumer/enrollee contracts, i.e., Evidence of Coverage, and program policies and procedures. The Standard Complaint Branch (SCB) incumbent is responsible for evaluating, monitoring and resolving standard complaints and health program activities, including complaints that have been forwarded by the Governor, Legislature, California Health & Human Services Agency, DMHC Director, or any of the DMHC's Executive offices. The incumbent will perform technical, consultative, and programmatic work within SCB. Please let us know how you heard about this position by taking a brief survey: DMHC Recruitment Survey. Leave Program (PLP) 2025 agreement: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time. You will find additional information about the job in the Duty Statement. Special Requirements • The position(s) require(s) a Background Investigation be cleared prior to being hired. All applicants not currently employed by the DMHC will be subject to a pre-employment background investigation. The investigation will consist of fingerprinting and an inquiry to the California Department of Justice to disclose criminal records. Any documents you submit for a job vacancy such as your state application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents include, but is not limited to, your Social Security Number (SSN), birthday, driver’s license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver’s license number will automatically be redacted upon submission. Possession of Minimum Qualifications will be verified prior to interview and/or appointment. If you are using education to meet the minimum qualifications for this position, you must submit a copy of your high school transcripts or college/university transcript(s). Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment. Desirable Qualifications In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate: • Knowledge of principles, practices, and trends with health care insurance; • Ability to work in a fast-paced and customer service-oriented program environment and to organize/prioritize workload to meet demands; • Ability to work well under pressure and meet deadlines; • Ability to perform multiple tasks with accuracy, precision and neatness; • Ability to thrive and work within a team environment; • Ability to provide accurate, clear, and timely advice and direction; • Independently resolve complex issues within a short timeframe; • Provide excellent oral and written communications; • Demonstrated ability to act independently, with open-mindedness, flexibility, and tact; • Ability to cultivate collaborative and cohesive working relationships with people in and outside of the team; • Knowledge and proficiency in the use of personal computers and standard office software (i.e. Outlook, Word, Excel, Access and PowerPoint.) Statement of Qualifications Instructions To be considered for this position, you must submit a Statement of Qualifications (SOQ) with your application. The response should be no more than two (2) pages using Arial 12-point font size. Include a title of “Statement of Qualifications” at the top. Include your name and the job control number in the right-side header. 1) Provide examples of your experience analyzing issues with reference to the appropriate interpretation and application of various laws, regulations, and/or policies and procedures. 2) Tell us about a time when you changed your style to work more effectively with a person from a different background. 3) Describe a situation in which you had to address a problem with a dissatisfied customer. Applicants who do not submit a SOQ with their application packet, in accordance with the instructions will be disqualified from consideration for this position. Cover letters, resumes and applications will not take the place of the SOQ.