Senior Claims Adjudicator - State Program Administrator Senior - Paid Leave

Working Title: Senior Claims Adjudicator

Job Class: State Program Administrator Senior

Agency: Department of Employment and Economic Development

• Job ID: 85556
• Location: St. Paul
• Telework Eligible: Yes, maybe 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: $27.84 - $40.82 / hourly; $58,129 - $85,232 / 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: 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 Senior Claims Adjudicator position performs advanced professional and specialized program support work for the Paid Leave division. The Senior Claims Adjudicator involves lead work and handles escalated claims, ensuring accurate adjudication and compliance with program guidelines. It also serves as a mentor to Claims Adjudicators and contributes to improving claims processes and quality standards. In addition, the Senior Claims Adjudicator is required to develop and maintain a comprehensive understanding of all procedural and administrative guidelines pertaining to Paid Leave.

Key Responsibilities:

• Provide effective and efficient review and processing of claims for the Paid Leave program: Process complex claims and claim tasks requiring a higher level of scrutiny. Review documentation and make informed decisions based on program guidelines. Provide effective and efficient review and adjudication of paid leave claims and processes involving medical conditions, legal challenges, or other sensitive matters. Ensure accuracy and compliance with program rules and SLAs (service level agreements).
• Mentoring and training: Provide mentoring and training to others on the team. Prioritize team engagement and offer thoughtful and supportive feedback to improve individual and overall team performance.
• 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.
• Other Duties as Assigned: 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. *Maybe 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.

Two (2) years* experience processing claims and/or appeals with one (1) of those years involving training, mentoring and/or coaching a team.

• 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:

• Experience resolving complicated and escalated claims.
• Experience working with other departments, external stakeholders and management to resolve cases.
• Experience auditing and ensuring claims are processed according to program standards and guidelines.
• Knowledge of state and federal regulations governing family and medical leave programs.
  
  

Preferred Qualifications

• Ability to manage claims with minimal supervision while meeting deadlines.
• Training and mentoring of other staff to enhance their claims processing abilities.
• Knowledge of techniques for detecting fraud and preventing erroneous claims.
• 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. (Diversity/Inclusion required qualification).
  
  

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.

How To Apply

Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers.

Connect 700 Program

To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Talent Acquisition at talent.acquisition.deed@state.mn.us.

Veterans

To be considered with Veteran's Status, you MUST indicate this on your application and submit a copy of your DD-214 form and other required documentation to talent.acquisition.deed@state.mn.us by the closing date.

Recently Separated Veterans (RSV): Effective July 1, 2009, legislation provides that the top five RSV applicants who apply and meet the qualifications for a vacancy shall be granted an interview.

Certain Disabled Veterans: Effective August 1, 2012, legislation provides state agencies with the option to appoint certain disabled veterans on a non-competitive basis.

See the above links for criteria and eligibility.

Current State Employees

• Please apply via Self Service.
• If eligible for bidding or expression of interest: This vacancy will be open for bids/expression of interest and all qualified applicants simultaneously. Current employees of DEED who are currently in the same classification, who are eligible, and apply within the seven (7) day period will be considered prior to filling the position by other means.
  
  

Contact

If you have questions about this position, contact Nellie Saunders at nellie.saunders@state.mn.us.

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.

EQUAL OPPORTUNITY EMPLOYERS

Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.

Applicants With Disabilities

Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.

The Department of Employment and Economic Development is an equal opportunity, affirmative action, and veteran-friendly employer, and encourages all qualified candidates to apply for job opportunities. If you are an individual with a disability who needs assistance or cannot access the online job application and search tools, please contact Karen Lilledahl at¿Karen.Lilledahl@state.mn.us. Please indicate what assistance is needed.