Working Title: Claims Specialist
Job Class: Health Care Claims Specialist
Agency: Human Services Dept
Job ID : 95748
Location : St. Paul
Telework Eligible : Yes
Full/Part Time : Full-Time
Regular/Temporary : Unlimited
Who May Apply : Open to all qualified job seekers
Date Posted : 07/23/2026
Closing Date : 07/29/2026
Hiring Agency/Seniority Unit : Human Services Dept / DHS Central Office AFSCME
Division/Unit : DHS-Central Office / HCA MPPS Claims Processing
Work Shift/Work Hours : Day Shift
Days of Work : Monday - Friday
Travel Required : No
Salary Range: $24.84 - $34.84 / hourly; $51,865 - $72,745 / annually
Classified Status : Classified
Bargaining Unit/Union : 207 - Technical/AFSCME
Work Area : G
FLSA Status : Nonexempt
Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes
This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.
The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
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.
The Claims Specialist will investigate and resolve highly complex health care claims and claims operations problems. Additionally, the person in this position uses areas of claims adjudication specialization in pricing, eligibility, adjustments, advances and Medicare crossover claims and a comprehensive understanding of claims processing operations policy, procedures and work flows to research work orders from the MPPS Provider Call Center and other areas across the Health Care Administration (HCA), and provide training and technical support to other areas within the agency. Responsibilities include:
Investigate and resolve highly complex health care claims and claims adjudication/claims processing operations problems
Link and coordinate efforts with other sections and related HCA areas as it relates to the investigation and resolution of county/provider problems, coordination of and uniform dissemination of policy and procedures information, and development of joint operations
Expedite the resolution of systems-related problem reports. Work with section management to set up processes and procedures for resolving system-related problems.Evaluate and facilitate resolution of problem reports from claims processors, providers, counties, and other HCA areas using the MMIS systems
Provide technical support and training. As part of a Claims Specialist responsibility be prepared to provide training and technical support to claims processing staff.Assess staff progress and level of preparation needed to use the MMIS to adjudicate claims
Monitor operations reports, prepare reports to account for unit activities as assigned, assist management with report monitoring, analysis, and generation activities
Facilitate transitions between systems and added enhancements. Facilitate transitions between Medicaid claims processing systems and subsequent enhancements. Research and define policy and operational differences between systems/system enhancements
Minimum Qualifications
Knowledge of health care claims operations, processes, and procedures
Knowledge of private third-party liability and Medicare payments
Ability to navigate multiple software applications, databases, multiple screens and data entry
Customer service skills sufficient to interact with a wide variety of customers in a professional manner
Basic math skills sufficient to add, subtract, multiply or divide correctly
Knowledge of medical terminology/coding
Strong communication skills sufficient to communicate clearly to both technical and non-technical clientele
Preferred Qualifications
Knowledge of the screening documents, medical and home care prior authorization forms, and waiver service agreements forms, and associated coding structures
understanding of the MMIS large scale claims processing systems as it relates to the review, correction, acceptance and/or denial, and processing of claims and other forms
Understanding of and ability to use Electronic Data Processing concepts and terminology
Thorough understanding of the MMIS large scale claims processing systems as it relates to the review, correction, acceptance and/or denial, and processing of claims and other forms
Variety of experiences working effectively with others from different backgrounds and cultures
Additional Requirements
To facilitate proper crediting, 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.
This position requires successful completion of the following:
It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:
Criminal background check
Reference check
Fingerprinting check (MNJIS/CJIS)
Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3 business days from the start of employment; and successfully obtain/retain CJIS certification annually.
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 careers@state.mn.us . Please indicate what assistance is needed.
