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Working Title: Claims Adjudicator

Job Class: State Program Administrator, Intermediate

Agency: Department of Employment and Economic Development

+ **Job ID** : 85350

+ **Location** : St. Paul

+ **Telework Eligible** : Yes, may be 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:** $25.29 - $36.71 / hourly; $52,805 - $76,650 / 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 Claims Adjudicator performs front-line, specialized program support work for the Paid Leave division. Under general supervision, the Claims Adjudicator provides effective and efficient review and processing of claims and direct support to applicants by offering guidance and maintaining clear communication throughout the claims process. The Claims Adjudicator is responsible for carrying out program activities to ensure eligibility requirements are met, documentation is provided as required and to ensure that program resources are properly expended. In addition, the Claims Adjudicator must meet accuracy and customer service standards while ensuring compliance with program guidelines.

Key Responsibilities:

+ **Provide effective and efficient review and processing of claims for the Paid Leave program:** Consistently meet accuracy and quality standards, service level agreements and ensure that compliance with program guidelines is always maintained.

+ **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.

+ **Cross-functional Program Support** : 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. *May be 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.

One (1) year* of experience processing claims and/or appeals.

*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:

+ Knowledge of best practices in customer service for addressing applicant inquiries and issues.

+ Ability to understand and explain complex regulations and requirements to applicants.

+ Experience entering and updating information in digital systems accurately and in a timely manner.

+ Ability to identify issues in claims applications and find solutions, i.e. requesting additional documentation or clarification.

+ Ability to manage a large volume of claims while meeting service level agreements, deadlines and program goals resulting in fair and timely decisions.

+ Ability to quickly adapt to changes in policies, procedures, or legislation impacting claims processing.

Preferred Qualifications

+ Knowledge of standard operating procedures for reviewing and processing claims.

+ Knowledge of data protection laws (e.g., HIPAA) and the handling of sensitive applicant information.

+ Knowledge of state and federal regulations regarding family and medical leave.

+ 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.

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.