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Working Title: Senior Claims Adjudicator

Job Class: State Program Administrator Senior

Agency: Department of Employment and Economic Development

+ **Job ID** : 85556

+ **Location** : St. Paul

+ **Telework Eligible** : Yes, maybe eligible for some telework.

+ **Full/Part Time** : Full-Time

+ **Regular/Temporary** : Unlimited

+ **Who May Apply** : This vacancy is open for bids and for all qualified job seekers simultaneously. Bidders will be considered through 04/20/2025.

+ **Date Posted** : 04/14/2025

+ **Closing Date** : 05/13/2025

+ **Hiring Agency/Seniority Unit** : Employment & Economic Development Department / MAPE

+ **Division/Unit** : Paid Family & Medical Leave

+ **Work Shift/Work Hours** : Day Shift, 8am to 4:30pm

+ **Days of Work** : Monday - Friday

+ **Travel Required** : No

+ **Salary Range:** $27.84 - $40.82 / hourly; $58,129 - $85,232 / annually

+ **Classified Status** : Classified

+ **Bargaining Unit/Union** : 214 - Minnesota Association of Professional Employees

+ **FLSA Status** : Nonexempt

+ Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

About the Paid Leave Division:

Paid Leave is a new program launching in 2026. The program will provide partial wage replacement to Minnesota workers who are out of work due to a qualifying condition, such as a severe health condition that prevents them from working, or when they need time to care for a family member or a new child. We are building a program that will be easy for every Minnesotan to use. We are engaging the people who depend on us—workers, employers, caregivers, and insurers—to learn from them and build the program around their needs. We are using modern service delivery and product practices to deliver the program. The Paid Leave team has high standards and an unrelenting commitment to serving Minnesotans. It is a start-up environment without legacy systems or preconceived ways of working, so we have a unique opportunity to create human-centric processes and systems to deliver this new benefit to Minnesotans.

Position Purpose:

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. In addition, the Senior Claims Adjudicator is required to develop and maintain a comprehensive understanding of all procedural and administrative guidelines pertaining to Paid Leave.

Key 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. Provide effective and efficient review and adjudication of paid leave claims and processes involving medical conditions, legal challenges, or other sensitive matters. Ensure accuracy and compliance with program rules and SLAs (service level agreements).

+ **Mentoring and training:** Provide mentoring and training to others on the team. Prioritize team engagement and offer thoughtful and supportive feedback to improve individual and overall team performance.

+ **Case Management** : Monitor, document, and follow-up on assigned claims. Partner with internal teams as needed to ensure program guidelines and Service Level Agreements (SLAs) are met.

+ **Other Duties as Assigned** : During program implementation, the Adjudicator may need to participate in supporting program needs. This could involve, but is not limited to, user acceptance testing (UAT), assisting the Contact Center by taking phone calls during periods of high call volume, and other duties as assigned.

This position is telework (https://mn.gov/mmb-stat/policies/1422-telework-2025.pdf) eligible. Staff are provided with the tools and equipment to be successful in a virtual work environment. Please note, the telework policy could change with notice based on business needs.

Anticipated start date is July 30, 2025, and onboarding will consist of two (2) to three (3) weeks of training. *Maybe subject to change.

This position will be open on a continuous basis until posted end date or until all positions are filled.

Minimum Qualifications

Please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held. Only applicants whose resumes clearly demonstrate fulfillment of each of these minimum qualifications will be considered for this position.

Two (2) years* experience processing claims and/or appeals with one (1) of those years involving training, mentoring and/or coaching a team.

*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.

Applicants that meet the above minimum qualification will be further evaluated on the following:

+ 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 standards and guidelines.

+ Knowledge of state and federal regulations governing family and medical leave programs.

Preferred Qualifications

+ Ability to manage claims with minimal supervision while meeting deadlines.

+ Training and mentoring of other staff to enhance their claims processing abilities.

+ Knowledge of techniques for detecting fraud and preventing erroneous claims.

+ Our employees are dedicated to ensuring cultural responsiveness. Preferred candidates will have a variety of experiences working effectively with others from different backgrounds and cultures. (Diversity/Inclusion required qualification).

Additional Requirements

A job offer will be contingent upon successfully passing a background check. The background check may consist of the following components:

+ Criminal Background Check

+ Employment Records Check (current and former State employees only)

+ Employment Reference Check

+ Conflict of Interest Review

+ Driver’s License and Records Check

The Minnesota Department of Employment and Economic Development will not sponsor applicants for work visas. All applicants must be legally authorized to work in the U.S.

AN EQUAL OPPORTUNITY EMPLOYER

Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.

Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email [email protected] . Please indicate what assistance is needed.