Tort Specialist - Human Services Program Specialist 2

About the role

The Tort Recovery Unit (TRU) within the Health Care Administration, Health Insurance Integrity and Accountability Division exists to assure that Medicaid is the payor of last resort in those cases where a third-party is liable to reimburse for medical expenses paid by DHS as a result of a personal injury. Medicaid must ensure that all third parties that have a responsibility pay their share.

Responsibilities

• Identifies, investigates, and prepares legal documentation supporting the recovery of third party funds for cases in which Medical Assistance (MA), Minnesota Health Care Programs (MHCP), and cash subsistence paid for injuries or wage loss covered or partially covered by: WC; No-Fault Auto; Third-Party Insurers; and in response to associated legal proceedings, including medical malpractice, restitution, products liability/class action, and homeowners’ claims.
• Reviews and evaluates merit of potential recovery in these cases using MMIS, MAXIS and other systems to legally establish DHS' position, and by and through an intervention or claim to recover funds paid by MHCP or DHS, based on state and federal law and recovery deadlines.
• Affords assistance to the unit supervisor, section manager, staff attorney, and division director with research and investigation activities, and responds to attorneys, court officials, local agency workers, and constituents.
• Communicates, educates, and shares unit policy and procedure and case information with local agency staff and fraud specialists to prevent misuse of funds.
• Understands and maintains a working knowledge of changes in state and federal requirements and case law relating to recovery of third-party funds for injuries.
• Ensures that his/her practices, decisions, and actions reflect mandates and DHS management objectives.

Requirements

• One (1) year experience working with caseloads that have a variety of internal and external participants. OR Three (3) years of experience working with human services, legal, or healthcare programs.
• Experience must demonstrate: Familiarity with the concept of insurance subrogation in the context of personal injury and workers’ compensation law. Ability to interpret and apply state and federal mandates and department policies and procedures.
• Advanced knowledge and comfort working with Microsoft Office Suite products, including ability to create and edit documents and spreadsheets and maintain unit internal resources.

Qualifications

• Professional experience with personal injury, workers’ compensation, or insurance industry.
• Strong interpersonal skills; strong verbal and written communication skills; and the ability to produce desired outcomes under broad policy direction.
• Case management experience.
• A comprehensive knowledge of MAXIS and MMIS eligibility.
• Ability to adapt to changing work environment, updates in systems and procedures and with changes in law and judicial decisions.
• Ability to efficiently manage time and apply logic in a work environment requiring fast and accurate response to time sensitive work load.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Skills

• Microsoft Office Suite proficiency.
• Knowledge of personal injury, workers’ compensation, or insurance industry.
• Interpersonal and communication skills.
• Case management experience.
• Adaptability to changing work environments.
• Time management and logical reasoning skills.

Benefits

• Paid vacation and sick leave.
• 12 paid holidays each year.
• Low-cost medical, dental, vision, and prescription drug plans.
• Fertility care, including IVF.
• 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.