Associate Claims Examiner

To Apply:

• These positions will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion, and merit employment rules.  Applications to this recruitment will be used to meet collective bargaining requirements.  Once any collective bargaining requirements have been met, all other applications may be considered.
• Interviews will be limited to candidates whose experience most closely meets the preferred qualifications, so please ensure that your application is complete and details your experience as outlined in this job posting.  Please note: You will be unable to make revisions once you submit your application into the JobAps system.
• For assistance in applying, please visit our 'Applicant Tips on How to Apply' page.
• The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
• Ensure that your application is complete and detailed before submitting it. In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. You will not be able to make revisions once your application is submitted into the JobAps system.

Important Next Step Information for After You Apply:

• Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process.
• This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the question's expiration date. Please regularly check your email and JobAps Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam.
• At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include: a cover letter, resume, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency. Applicants must meet the minimum qualifications as indicated to apply for this position.
• All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period. It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception. Requests should be made to DAS.SHRM@ct.gov.
• Due to the large volume of applications received, the Department of Administrative Services is unable to provide confirmation of receipt or status during the recruitment process. Updates will be available through your JobAps portal account.

Connect With Us:

• If you have any questions pertaining to this recruitment, please contact Rocky Young at rocky.young@ct.gov and reference the recruitment number. 
• Follow the State of Connecticut on LinkedIn.

DEPARTMENT OF SOCIAL SERVICES AND OFFICE OF THE TREASURER: This class is accountable for performing the most complex tasks related to the examination of claims and supporting documentation for validity, legality and subsequent approval for payment.

OFFICES OF POLICY AND MANAGEMENT [INTERGOVERNMENTAL RELATIONS DIVISION] AND STATE COMPTROLLER: This class is accountable for acting as a working supervisor for Claims Examiners engaged in examining claims and supporting documentation for validity, legality and subsequent approval for payment.

DEPARTMENT OF SOCIAL SERVICES: Performs specialized duties relating to examination of claims for convalescent care benefits; ensures Medicaid is payor of last resort by reviewing client coverage for Medicare or private health insurance submitted by providers; determines correct payment authorization by applying knowledge of agency policy, state statute and federal regulations; determines proper payment authorization date by identifying third party payment amounts and coverage dates and applying these to benefit claims; reconciles suspect duplicate claims identified by payment contractor and approves correct payment and/or initiates recovery of inappropriately paid claim; analyzes Medicare reconsideration listings or reversals received from Third Party Liability unit to determine proper payment authorization or recovery; acts as liaison for assigned facility for payments processing and recovery; provides training for facility staff regarding payment authorization requirements and policies; documents overpayments through review of various records and reports and determination of correct benefit periods; initiates recovery of Medicaid benefits for claims paid prior to application of other available medical coverage; receives and responds to high volume of telephone calls and written correspondence regarding billing problems, denied claims and other issues from a variety of individuals; performs related duties as required.

OFFICES OF POLICY AND MANAGEMENT [INTERGOVERNMENTAL RELATIONS DIVISION] AND STATE COMPTROLLER: Plans unit workflow and determines priorities; schedules, assigns, oversees, and reviews work; establishes and maintains unit procedures; provides staff training and assistance; conducts or assists in conducting performance evaluations; acts as liaison with operating units, agencies and outside officials regarding unit policies and procedures; performs a full range of liability and expenditure audits of the State of Connecticut with emphasis on most complex audit requirements; coordinates and monitors work of employees performing audit of liabilities and expenditures for validity, legality and propriety; attends meetings with state agencies regarding audit items; advises and instructs state on liability and expenditure matters; prepares analytical and audit reports; provides information to Auditors of Public Accounts as necessary; trains new Claims Examiners as necessary; may make recommendations on polices or standards; may prepare reports and correspondence; performs related duties as required.

OFFICE OF THE TREASURER: Performs specialized duties related to examination of claims for purposes of returning people to work, negotiating settlements and uncovering fraud; develops or assists in development of indemnity and medical reserves as well as reserve reassessment based upon new information or a change in circumstance; develops and implements claim file action plan by interpreting medical reports and utilizing in-house and outside resources including but not limited to independent medical evaluations, surveillance, Attorney General referral and/or vocational assistance; identifies and resolves disputed issues pursuant to Connecticut General Statute Chapter 568; prepares for and attends Workers Compensation hearings as needed; performs related duties as required.

Knowledge of relevant state laws and regulations; knowledge of auditing and record keeping procedures; some knowledge of reserving techniques; interpersonal skills; oral and written communication skills; negotiation skills; analytical skills; skill in performing arithmetical computations; ability to read, understand and apply laws and regulations; ability to examine and analyze highly complex claims; ability to schedule and prioritize workflow; ability to operate office equipment; ability to operate office suite software; some supervisory ability.

Five (5) years of experience in highly complex clerical work involving financial record keeping, auditing, accounting, purchasing or claim processing.

One (1) year of the General Experience must have included accounts payable and/or claims auditing.

Note: For state employees experience in highly complex clerical work is interpreted as experience obtained at the level of Financial Clerk

1. College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equalling one-half (1/2) year of experience to a maximum of four (4) years for a Bachelor's degree.
2. One (1) year as a Claims Examiner may be substituted for the General and Special Experience.
3. Possession of a current State of Connecticut Workers Compensation Casualty Adjuster License may be substituted for one (1) year of the General Experience.

• Experience with examining and interpreting Medicare and Medicaid documents and Private Insurance policies.
• Experience researching, obtaining and updating data in electronic systems
• Experience with communicating with agency staff and others
• Experience prioritizing workflow to meet deadlines

AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.