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Working Title: Claims Adjudication Manager

Job Class: State Program Administrator, Director

Agency: Department of Employment and Economic Development

• Job ID : 82200

• Location : St. Paul

• Telework Eligible : Yes, may be eligible to telework up to four (4) days per week

• Full/Part Time : Full-Time

• Regular/Temporary : Unlimited

• Who May Apply : This vacancy is open for expressions of interest and for all qualified job seekers simultaneously. Expressions of interest should be submitted by 12/06/2024.

• Date Posted : 11/28/2024

• Closing Date : 12/09/2024

• Hiring Agency/Seniority Unit : Employment & Economic Development Department - Minnesota Management Association

• 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: $37.60 - $54.16 / hourly; $78,508 - $113,086 / annually

• Classified Status : Classified

• Bargaining Unit/Union : 216 - Middle Management Association/Minnesota Management Association

• FLSA Status : Exempt - Executive

• Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : 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 Claims Adjudication Manager provides leadership, direction, and oversight for the Paid Leave claims administration function. The Claims Adjudication Manager is responsible for overseeing the day-to-day activities of claim adjudication, ensuring the delivery of high-quality decisioning and meeting performance metrics. This position works under general administrative oversight of the Senior Manager of claims Administration.

The Manager will also have the opportunity to participate in the implementation of the claims adjudication processes, including the development of technology, policies, and procedures, and building the adjudication organization. Ongoing, the Manager will maintain a comprehensive understanding of adjudication trends, ensuring consistent policy application and identifying opportunities for process improvements.

Key responsibilities include:

• Collaborating cross-functionally with other Paid Leave teams to drive process and performance improvement.

• Ensuring end-to-end quality while understanding and addressing risk and compliance issues.

• Development and maintenance of process waste and application/adjudication issues and partner with Product and Strategy teams to recommend policy and technology improvements.

• Build adjudication capabilities: Participate in the implementation of the adjudication operation, including supporting the development of technology, operational dashboards, metrics, process documentation, training topics and content, and Knowledge Base content.

• Lead and develop a high-performing team: Provide leadership, motivation, and opportunities for growth to a team of 25-35 claims adjudicators, ensuring adherence to service level agreements and quality standards.

• Policy and process advocacy: Analyze and interpret claims data to understand operational trends and constituent experiences. Identify and implement improvements to streamline the claims process and enhance user satisfaction.

• Subject matter expertise: During the implementation phase, represent the claims adjudication team in process and system design and testing to ensure tools and workflows support efficient claims management.

• Startup environment: Be prepared to adapt and take a hands-on approach in the early phases of the program, assisting with claim reviews as necessary and supporting iterative growth of the team and processes.

This position is telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) eligible and is occasionally required to be on-site at the St. Paul office. Staff are provided with the tools and equipment to be successful in a virtual work environment and may telework from anywhere in Minnesota or a neighboring state. Please note, the telework policy could change with notice based on business needs.

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.

Four (4)* years of experience in a claims adjudication or related leadership position, with at least two (2) of those years managing teams to achieve organizational goals in productivity and quality.

*Bachelor’s degree in Business Administration, Public Administration, Community Development, Economics, or other closely related field as determined by the agency may substitute one (1) year of experience;

Applicants that meet the above minimum qualification will be further evaluated on the following:

• Knowledge of claims processing best practices and technologies, with understanding of compliance and regulatory requirements, as well as expertise in managing claims adjudication processes at scale.

• Ability to meet and measure operational performance metrics.

• Ability to coach, mentor, and develop a team.

• Ability to analyze data and drive strategic improvements.

• Experience collaborating with internal and external stakeholders.

Preferred Qualifications

• Knowledge of data analysis tools for monitoring team performance and quality control.

• Experience managing a large, diverse, and distributed team.

• Experience designing or improving claims adjudication processes.

• Understanding of relevant laws, regulations, and policies (e.g., insurance, paid leave statutes, healthcare regulations).

• Knowledge of fraud prevention measures and risk management practices.

• Skilled in workforce management, including staffing optimization and performance metric tracking.

• 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.

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 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.

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.