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Claims Adjudication Manager - State Program Administrator Director - Paid Leave

Minnesota Department of Employment and Economic Development

Minnesota Department of Employment and Economic Development

St Paul, MN, USA
Posted on Nov 29, 2024
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: 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 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.

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.