Ombudsman I

Ombudsman I-
**Essential Job Functions**:
EJF 1. On a daily basis, follow unit procedures to provide courteous and professional service on all contacts received by the general public, providers, advocacy groups, HHS program areas, Texas Department of Criminal Justice (TDCJ) inmates, and other stakeholders. Resolve moderately to complex issues and complaints by:

- Performing in-depth analysis of moderate to complex issues and complaints which includes: researching and interpreting state and federal rules and regulations, agency procedures, and client rights and responsibilities, including Texas Works and Medicaid for the Elderly and People with Disabilities handbooks, as well as other HHS programs; interpreting client specific information in HHS and vendor eligibility and enrollment systems, and researching the internet; and determining whether a complaint may be handled within the initial contact or requires escalation for the purpose of investigation.
- If upon research, additional issues/errors are identified, escalate the issue/error to Ombudsman III staff or HHS program areas to be addressed and make recommendations of actions to achieve final resolution. Requests responses regarding complaints from HHS program staff, including prompting for responses to determine final resolution of complaints.
- Making initial contacts by phone or in writing to HHS clients, providers, HHS program areas, Managed Care Organizations, advocacy organizations, HHS vendors, and/or local resources to mediate resolutions of issues and complaints.
- Making determinations regarding program and policy compliance.
- Escalating complex issues that cannot be resolved within initial contact to Ombudsman III staff with recommendations for actions to achieve final resolution.
- Providing accurate and appropriate information and referrals to HHS clients regarding other HHS program areas and vendors, other state agencies, and local resources.
- Educating and advising the general public and stakeholders on HHS programs and services, procedures, state and federal rules and regulations, the Fair Hearing and appeal process, and empowering HHS clients to navigate the HHS system and advocate for themselves when possible.
(35%)- EJF 3. On a daily basis, accurately and thoroughly document all issues, actions, analysis, findings, and resolutions in the Ombudsman database. (20%)
- EJ4. Report to Ombudsman management recurring issues and problem trends that may affect the administration of HHS programs management, with recommendations for improvement to include HHS policy/procedure changes, changes to TAC, or vendor contract changes. (5%)
- EJ5. Other duties assigned**Knowledge Skills Abilities**:
a. Knowledge of health and human services programs, services and procedures.
- b. Knowledge of applicable rules, regulations, policies, and functions of the Commission
- c. Skill in working on an Automated Call Distribution (ACD) hotline.
- d. Skill in communicating effectively both verbally and in writing.
- e. Skill in establishing and maintaining effective working relationships, including the ability to work with people under pressure, and resolve conflicts.
- f. Skill in using eligibility and claims databases.
- g. Skill in conducting research and complaint resolution.
- h. Skill in analyzing and preparing documents, reports and correspondence.
- i. Skill in researching complaints and recognizing and resolving problems.
- j. Ability to determine the complexity of the issue and triage to the appropriate agency or program.
- k. Ability to conduct research using the Internet and other sources.- m. Ability to use an automated tracking system.
- n. Ability to work and communicate with individuals in personal crises and in confrontative situations as evidenced by the ability to maintain control of an interview.
- o. Ability to elicit factual information or perform required duties in order to prepare for an investigation.
- p. Ability to interact with all clients, internal and external, using empathy and compassion.**Registration or Licensure Requirements**:
None

**Initial Selection Criteria**:
A minimum of 2 years of current experience determining eligibility for Texas Works programs (TANF, Medicaid and SNAP Food Benefits, etc). Experience handling complaints is preferred. Experience working in a call center environment is preferred.

**Additional Information**:
Employees will telework 100% from anywhere in Texas, consistent with HHS telework policies. Employees are responsible for providing the necessary infrastructure for working at home, including office furnishings (desk, chair, lamps, etc.), and utilities (reliable internet, electricity, telephone). The agency will not reimburse for utilities or any items purchased for use at home, including office supplies, internet service, or maintenance or repair of personally owned equipment. Travel to a regional HHS office for pick up or repair of HHS-issued equipment may be required.

**MOS Code**:
No equivale