Medical Claims Coordinator

Medical Claims Coordinator (Open)We're seeking candidates who bring a strong attention to detail and a commitment to accuracy, along with the ability to work effectively in a structured, fast-paced environment. Join Our Team Are you looking for a workplace where your attention to detail, passion for helping others, and love for teamwork are valued and make a difference every day? Join our dedicated team at the Department of Health and Human Services as a Medical Claims Coordinator in our Medicaid and Long-Term Care Claims Division. We are committed to service, collaboration, and making an impact on the lives of Nebraskans and we like to have a little fun along the wayAs a Medical Claims Coordinator for the Recovery and Cost Avoidance team you'll play a vital role in ensuring Medicaid appropriately remains the payor of last resort for health and casualty claims. This detail-oriented role involves investigating the circumstances surrounding health claims when there is indication that payment for the claim may be obtained from sources other than Title XIX Medicaid funds.As a Medical Claims Coordinator, you will:Answer and direct calls placed or referred to the Coordination of Benefits /Casualty call line.Analyze claims for payor accuracy, investigate and resolve liability issues, and ensure compliance with Medicaid policies and procedures.Communicate with team members to address claim inquiries and support both internal teams and external partners.Initiate research and bring resolution to processed claims which may have been processed and paid and now need to be recouped and billed to a liable third-party resource.Research extent and sources of third-party liability for medical claims payment and ensure these payments are fully utilized.Perform Third Party verifications and accurately enter the findings into a database.Collaborate with appropriate program staff to report and follow-up if fraud, waste or abuse activities are identified.Perform related work as assigned.Hiring Rate: $21.041 per hour. Non-ExemptLocation: Lincoln NE NSOB 5th floor- In office onlyRequirements / Qualifications:Minimum Qualifications: Bachelor's degree in business administration, management, public administration, accounting, behavioral sciences, or a closely related field AND one year of investigative research experience OR five years' continued education and/or experience in a field such as public or business administration, accounting, or any discipline related to the work assigned. Any equivalent combination of education and experience will be considered.Preferred Qualifications:Experience with health insurance terminology/processes, Microsoft Office (Excel, Word, Outlook, etc.) databases, Medicaid Claims Processing, and Medicaid eligibility. Experience with C1/MMIS, N-FOCUS, and OnBase would be beneficial.Strong analytical and problem-solving skills, including the ability to interpret and apply regulations, identify discrepancies, and recommend appropriate actions.A professional, customer-focused approach when communicating with providers, clients, business partners and internal team members.Comfort using multiple computer systems and databases to research, update, verify and manage insurance related information efficiently.If you're detail-oriented, dependable, and ready to support our mission of helping Nebraskans we'd love to hear from youKnowledge, Skills, and AbilitiesCustomer Service Skills Ability to communicate clearly, listen actively, and handle questions or complaints with professionalism.Attention to Detail Able to review forms and data accurately to catch errors or missing information.Computer Proficiency Comfortable using Microsoft Office (Word, Excel, Outlook) and navigating multiple computer systems.Time Management Capable of handling a high volume of work, staying organized, and meeting deadlines.Problem-Solving Able to identify issues, think critically, and find practical solutions for customers or internal processes.Communication Skills Strong written and verbal communication to explain processes, respond to inquiries, and document work.Teamwork Willing to work cooperatively with others and assist team members when needed.Adaptability Able to learn new systems, take on different tasks, and adjust to changes in a fast-paced environment.Confidentiality Awareness Understands and follows privacy regulations like HIPAA when handling sensitive information.What we offer:State-matched retirement contribution of 156%13 paid holidaysGenerous leave accruals that begin immediatelyTuition reimbursement program79% employer-paid health insurance plansDental and vision insurance plansEmployer-paid $20,000 life insurance policyCareer advancement opportunities as the largest and most diverse employer in the stateTraining and development based on your career goalsEmployee Assistance ProgramIf you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: https://link.nebraska.gov/BenefitsWe offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation. Check out all that the State of Nebraska has to offer Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefitsEqual Opportunity StatementThe State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.