Claims Investigation Agent

Commonwealth of PA | Dauphin County, PA

Posted Date 12/03/2019
Description
  1. This position assists with the recovery of medical assistance expenditures that were incorrectly or provisionally paid on behalf of Department of Human Services (DHS) recipients. This is a statewide program, which is headquartered in the Recovery Section, Division of Third Party Liability, Bureau of Program Integrity, Office of Administration.

IMPORTANT:  YOU MUST APPLY TO THIS VACANCY POSTING, MEET ELIGIBILITY REQUIREMENTS, COMPLETE THE SUPPLEMENTAL QUESTIONS, AND RECEIVE A SCORE.  YOUR SCORE IS ONLY VALID FOR THIS SPECIFIC VACANCY.  ONCE THIS POSITION IS FILLED, YOUR SCORE IS NO LONGER VALID.
  • Full-time employment
  • Work Hours:  Monday thru Friday, 8:00AM - 4:00PM with a 30 minute lunch
Investigate cash and medical assistance claims for personal injury and estate cases by employing independent judgment through verbal and written communications with attorneys, insurance adjusters, medical providers, police departments, recipients, other Commonwealth agencies and public inquires, in order to protect the Department's claim.

Maintain a working knowledge of the claims computation process and relevant documents in order to analyze, interpret and defend the legitimacy of the claim with interested parties. Maintains a working knowledge of the Automated Statement of Claim system.

Maintain the integrity of the individual active case records by thoroughly reviewing cases distributed on a daily basis, recording significant events, and initiating appropriate follow-up measures. Accuracy must be maintained in order to facilitate future review and comprehension.
 
 
 Qualifications:
  • Must meet PA residency requirement  - For more information on ways to meet PA residency requirements, follow the link and click on Residency
  • Minimum Experience and Training Requirements - Four years of investigative public contact experience requiring the review and presentation of records, correspondence and documents used in the prosecution of cases, approval of claims or credit, or collection of debts; OR a bachelor's degree in Pre-law, Criminal Justice, Police Science, or a closely related field; OR an equivalent combination of experience and training
  • Based on your answers to the application supplemental questions regarding education, you may be instructed to attach a copy of your college transcript(s) to your application.
  • Must be able to perform essential job functions
Veterans: Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs.  To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.

Telecommunications Relay Service (TRS):  711 (hearing and speech disabilities or other individuals)

The Commonwealth of Pennsylvania is proud to be an equal opportunity employer supporting workplace diversity.
  • Score valid for this specific posting only
  • Score based on information reported on application and supplemental questions
  • Provide complete and accurate information or:
    • score may be lower than deserved
    • application processing may be delayed
    • disqualification may result
  • May only test once under this announcement
  • Email notice of test results provided

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