Customer Service Representative / Claims Examiner

Salary : See Position Description

Location : Salt Lake County, UT

Job Type : Full Time

Job Number : 44006

Agency : 250 Health & Human Services

Unit : 3115 DHHS DIH Medicaid Operations

Opening Date : 01 / 24 / 2025

Closing Date : Continuous

FLSA : Non-Exempt

Recruiter : Angie Rhodes, arhodes@utah.gov

of Openings : 1

Schedule Code : TL - Time Limited - This is a career service exempt at will position.

Background Check : You must successfully pass a criminal history check.

Location : Cannon Health Building288 North 1460 WestSalt Lake City, UT 84116The Utah Department of Health is proud to be a tobacco free campus.

Schedule Code Description : These positions are time- limited, but may convert to a permanent position at a later date. DHRM rules apply.

Benefits : This position is eligible for a full benefits package. See benefits tab below for details.

EEO Statement : The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, dial 711 or TTY : 800-346-4128.

Job Description

Do you enjoy providing great customer service? Do you have experience with medical billing or claims? If you answered yes to these questions the Office of Medicaid Operations with the Utah Department of Health and Human Services invites you to appy as a Medicaid Claims Examiner II.

The Medicaid Claims Examiner II position has two primary functions, to answer incoming customer service calls and to process all types of medical claims based on Medicaid guidelines. You will be required to be logged into the phone system for up to 7 hours / day and take between 70 to 100 calls a day. After training, this position may be eligible to telework from home for up to 3 days per week, with 2 in-office days.

Principal Duties

As a Medicaid Claims Examiner II you will :

• Answer calls about Medicaid benefits, claims, billing practices, and other related information from the medical community and public.
• Adjudicate claims.
• Respond to phone, electronic, fax and mail inquiries regarding the status and correction of claims.
• Explain and interpret Medicaid billing policies, guidelines, benefits and procedures.
• May spend time in the document control area.

This job may be filled at either of the levels listed below. (Rates as listed or in accordance with DHRM Rule for current state employee.)

The Ideal Candidate has

Why You Should Join Our Team

Note : as of April 8, 2024, DHHS employees will be working a hybrid schedule, which includes 2 office days per week and 3 telework days.

Why work for the Utah Department of Health and Human Services? In addition to the rich the State of Utah offers, the department offers :

If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clicking here.

The Agency

For more information on the Utah Department of Health and Human Services, please click here

Supplemental Information

Benefits :

The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page : To access a Total Compensation Calculator in Excel format click

FMLA General Notice :

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Your answers to the questions on this posting must be supported by the duties, experience, andinformation listed in your profile's work and education history, not your resume. Please select "YES" to indicate you understand the validity of your claims will be based upon information contained within your application, not your resume. Unsubstantiated claims, exclusion of information, or incomplete answers may result in the disqualification of your application or of the question. Entering "see resume" will be considered an incomplete answer.

Please indicate how you heard about this specific job posting.

In applying for this position, I understand that any offer of employment would be contingent upon me successfully completing a background screening as per the Utah Department of Health and Human Services Background Screening Policy and that might start date might change if the background check is not back by the originial start date. . Link to the policy can be found in the job description.

Are you a current employee of the Utah Department of Health and Human Services (DHHS)?

This position requires frequent, professional interaction with the public and providers. How many years of professional experience do you have responding to customer questions and needs while ensuring compliance with policy / procedures?

How many years of experience do you have providing customer service to individuals in person or over the phone?

Please briefly describe your customer service experience and where you obtained this experience.

Do you have professional working experience with medical billing or collections?

Please select all of the following software applications you are proficient with using.

Required Question

Salary : $19 - $32