Senior Claims Adjudicator - State Program Administrator Senior

About the role

The Senior Claims Adjudicator position performs advanced professional and specialized program support work for the Paid Leave division. The Senior Claims Adjudicator involves lead work and handles escalated claims, ensuring accurate adjudication and compliance with program guidelines. It also serves as a mentor to Claims Adjudicators and contributes to improving claims processes and quality standards.

Responsibilities

• Provide effective and efficient review and processing of claims for the Paid Leave program: Process complex claims and claim tasks requiring a higher level of scrutiny. Review documentation and make informed decisions based on program guidelines.
• Ensure accuracy and compliance with program rules and Service Level Agreements (SLAs).
• Mentoring and training: Provide mentoring and training to others on the team.
• Case Management: Monitor, document, and follow-up on assigned claims. Partner with internal teams as needed to ensure program guidelines and SLAs are met.

Requirements

• Two (2) years* experience in claims, appeals, case management operations, or contact center support for an eligibility or claims-based program with one (1) year involving training, mentoring and/or coaching a team in any type of lead role.
• Associate's degree in Business Administration, Public Administration, Community Development, Economics, Human Resources, other closely related field as determined by the agency may substitute six (6) months of experience; bachelor's degree substitutes for one (1) year of experience; master's degree substitutes for eighteen (18) months of experience.

Qualifications

• Experience resolving complicated and escalated claims.
• Experience working with other departments, external stakeholders and management to resolve cases.
• Experience auditing and ensuring claims are processed according to program requirements and guidelines.
• Knowledge of state and federal regulations governing family and medical leave programs.

Skills

• Ability to manage claims with minimal supervision while meeting deadlines.
• Experience in training and mentoring of other staff to enhance their claims processing abilities.
• Knowledge of techniques for detecting fraud and preventing erroneous claims.

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well. Your benefits may include: Paid vacation and sick leave, 12 paid holidays each year, Low-cost medical, dental, vision, and prescription drug plans, Fertility care, including IVF, Diabetes care, Dental and orthodontic care for adults and children, 6 weeks paid leave for parents of newborn or newly adopted children, Pension plan that provides income when you retire (after working at least three years), Employer paid life insurance to provide support for your family in the event of death, Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury, Tax-free expense accounts for health, dental, and dependent care, Resources that provide support and promote physical, emotional, social, and financial well-being, Support to help you reach your career goals: Training, classes, and professional development, Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov), Employee Assistance Program (EAP) for work/life support: A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance, Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues, Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care, Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

Pay

$28.75 - $42.16 / hourly; $60,030 - $88,030 / annually

Schedule

Day Shift, 8:00AM to 4:30PM