Claims Adjudicator

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 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.

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your benefits may include:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
• Fertility care, including IVF
• Diabetes care
• Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being

Support to help you reach your career goals:

• Training, classes, and professional development
• Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)

Employee Assistance Program (EAP) for work/life support:

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.