Ombudsman Consumer Health Assistant- Unclassified

Posting number: 2026-03534

Department: DHS - AGING AND DISABILITY SERVICES DIVISION

Job classification: Unclassified

Posting type: Open Competitive

Categories: Health Care Support

The Aging and Disability Services Division (ADSD) is currently recruiting for a full-time Ombudsman position in Las Vegas, Reno, Carson City, Elko, or Ely, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following program: Office of Consumer Health Assistance (OCHA). Under the general direction of the Chief, Elder Right, the Ombudsman will assist consumers and injured employees in understanding their rights and responsibilities under health care plans, including, without limitation, the Public Employees’ Benefits Program, and policies of industrial insurance. The incumbent identifies and investigates complaints of consumers and injured employees regarding their health care plans and will refer consumers and injured employees to the appropriate agency, department or other entity that is responsible for addressing the specific complaint of the consumer or injured employee. This position facilitates access to healthcare resources for the uninsured and underinsured. The incumbent completes arbitrations for the Nevada surprise billing law. The Ombudsman will take such actions as are necessary to ensure public awareness of the existence and purpose of the services provided by OCHA. Assist consumers with filing complaints against health care facilities and health care professionals. Assign external review organizations concerning adverse determinations from a health carrier. The incumbent will build and maintain collaborative relationships with insurers, medical providers, social services, and government agencies, maintain a current knowledge of trends, policies, resources and laws pertaining to insurance benefits, including insurance laws and regulations. The mission of ADSD is to empower individuals and their support systems by providing resources for disabilities and aging - connecting Nevadans to services and improving their quality of life.

• Minimum of five years of experience in health care navigation, workers’ compensation, health insurance, and medical billing.
• Experience working with both Medicaid and Medicare plans.
• Demonstrated experience working directly with consumers, resolving complaints, and navigating complex systems.
• Proven background in advocacy within health care or related fields.

• -Coordinating and participating in community outreach events.
• -Building and maintaining partnerships with community resource agencies and health care organizations to increase public awareness of OCHA services.
• Arbitration Responsibilities
• -Conducting arbitrations to resolve disputes between out of network providers/facilities and health plans for medically necessary emergency service claims under $5,000.
• Health care policy knowledge
• Health insurance carrier operations
• Provider/facility billing and claims experience
• Workers’ compensation system knowledge
• Regulatory and statutory compliance
• External review process administration
• Arbitration or dispute resolution procedures
• Report writing and documentation
• Understanding of hospital billing and patient rights
• Strong communication and public facing skills
• Empathy and consumer focused mindset
• Critical thinking and problem solving
• Diplomacy and conflict resolution
• Integrity and ethical decision making
• Ability to remain neutral and objective
• Relationship building and collaboration
• Adaptability and resilience
• Sound judgment under pressure
• Attention to detail
• Professionalism and discretion

Inform, educate, and advocate for injured workers and consumers by:

-Responding to written and telephonic inquiries related to health care and workers’ compensation.

-Assisting consumers and injured employees in understanding their rights and responsibilities under their health care plans.

-Identifying, investigating, and helping resolve complaints regarding health care plans.

-Providing information in clear, understandable language about workers’ compensation and health care coverage.

-Contacting insurance companies, medical providers, and employers to advocate on behalf of injured workers and consumers.

-Assisting consumers with access to medical, dental, vision, prescription drug, and mental health services.

-Helping consumers access navigators, case managers, or facilitators for health care services.

-Assisting consumers with scheduling appointments with in network health care providers.

-Collaborating with governmental, private, and nonprofit organizations to resolve consumer issues.

-Negotiating with insurers, medical providers, or medical facilities to reach appropriate resolutions.

-Facilitating access to health care resources for uninsured or underinsured consumers.

-Assisting consumers with filing complaints against health care facilities and professionals.

-Referring complaints or the results of investigations to the Attorney General when appropriate.

-Assisting consumers with filing complaints with the Commissioner of Insurance regarding health plan issuers.

-Hearing, mediating, arbitrating, or resolving disputes between patients and hospitals.

-Assigning independent review organizations for adverse determinations from health plans.

-Entering timely and accurate case notes into the OCHA database.

-Preparing and sending correspondence to injured workers, consumers, insurers, and providers.

-Maintaining systems to collect and track information related to written and telephonic inquiries received by OCHA.