Job Information
State of Maine, Bureau of Human Resources Supervisor Professional Claims Review in Augusta, Maine
Supervisor Professional Claims Review
Augusta , Maine , United States | Community & Social Services | Full-time
Apply by: Feb. 28, 2025
Apply with Linkedin Apply
Department of Health and Human Services (DHHS)Opening Date:February 14, 2025Closing Date: February 28, 2025Job Class Code:5082Grade:25 (Supervisory Services)Salary:$57,408.00 - $81,078.40 per yearPosition Number:02031-2337Location: Augusta
Only Employees with Promotional Status in the Department of Health and Human Services May Apply
Core Responsibilities:
As Supervisor Professional Claims Review, you will oversee the day-to-day activities of the Claims Adjustment Unit. You will provide supervision, leadership and direction to seven full-time staff and have primary responsibility for ensuring the unit consistently and effectively provides resources and support to MaineCare providers and members, as well as other state/federal agencies. You will help staff interpret MaineCare policy and support them in resolving complicated claims problems. You will review policies and procedures and make recommendations for development and revision of MaineCare policies/procedures as appropriate. You will partner with technical staff and other program staff to identify and resolve ongoing issues with the MaineCare Claims Management System.
Minimum Qualifications:
A Bachelors Degree in Public Health, Nursing, Community Health, Health Administration, or related field and four (4) years administrative and/or supervisory experience in the areas of hospital, public health, chronic disease, nursing, or related field -OR- acceptable equivalent combination of education and related professional experience.
Preference will be given to those with customer contact experience in a related healthcare environment, and significant health plan provider relations experience and at least two years’ experience explaining and interpreting Medicaid rules and regulations.
The background of well-qualified candidates will demonstrate the following competencies:
An ongoing commitment to OMS organizational core values of accountability, integrity, respect, customer service, collaboration, and personal growth.
A proven ability to investigate and resolve complex medical and insurance billing issues.
A proven ability to explain complex technical information to consumers and others.
A history that demonstrates effective leadership, coaching and supervisory skills.
Thinking about applying?
Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your lived experience and passion set you apart.
Agency information:
TheDepartment of Health and Human Services (https://www.maine.gov/dhhs/) (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.
The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.
The Claims Adjustment Unit within OMS supports health care providers enrolled with MaineCare by performing claim adjustments for appropriate and accurate reimbursement related to rate changes, CR and TR changes, provider requested adjustments, and other identified claim adjustments to assure compliance with MaineCare policy.
Application Information:
Please submit all documents or files in PDF format.
For additional information about this position please contact Heidi Brann at 207-624-6926.
To request a paper application, please contact Mandy.Hernandez@Maine.gov
Benefits of working for the State of Maine:
No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:
Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays , 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($11,196.96 - $12,514.32 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($387.92 annual value).
Retirement Plan – The State contributes the equivalent of 13.29% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receivesix weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act (https://www.maine.gov/bhr/state-employees/workplace-posters) .
State employees are eligible for an extensive and highly competitive benefits package (https://www.maine.gov/bhr/state-jobs/compensation-benefits) , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness (https://www.maine.gov/bhr/oeh/) .
Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.
There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role.
As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.
If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.
