Working Title: Claims Specialist
Job Class: Health Care Claims Specialist
Agency: Human Services Dept
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Job ID: 95748
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Location: St. Paul
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Telework Eligible: Yes
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Full/Part Time: Full-Time
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Regular/Temporary: Unlimited
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Who May Apply: Open to all qualified job seekers
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Date Posted: 07/23/2026
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Closing Date: 07/29/2026
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Hiring Agency/Seniority Unit: Human Services Dept / DHS Central Office AFSCME
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Division/Unit: DHS-Central Office / HCA MPPS Claims Processing
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Work Shift/Work Hours: Day Shift
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Days of Work: Monday - Friday
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Travel Required: No
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Salary Range: $24.84 - $34.84 / hourly; $51,865 - $72,745 / annually
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Classified Status: Classified
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Bargaining Unit/Union: 207 - Technical/AFSCME
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Work Area: G
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FLSA Status: Nonexempt
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Designated in Connect 700 Program for Applicants with Disabilities: Yes
This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.
The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
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.
The Claims Specialist will investigate and resolve highly complex health care claims and claims operations problems. Additionally, the person in this position uses areas of claims adjudication specialization in pricing, eligibility, adjustments, advances and Medicare crossover claims and a comprehensive understanding of claims processing operations policy, procedures and work flows to research work orders from the MPPS Provider Call Center and other areas across the Health Care Administration (HCA), and provide training and technical support to other areas within the agency. Responsibilities include:
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Investigate and resolve highly complex health care claims and claims adjudication/claims processing operations problems
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Link and coordinate efforts with other sections and related HCA areas as it relates to the investigation and resolution of county/provider problems, coordination of and uniform dissemination of policy and procedures information, and development of joint operations
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Expedite the resolution of systems-related problem reports. Work with section management to set up processes and procedures for resolving system-related problems. Evaluate and facilitate resolution of problem reports from claims processors, providers, counties, and other HCA areas using the MMIS systems
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Provide technical support and training. As part of a Claims Specialist responsibility be prepared to provide training and technical support to claims processing staff. Assess staff progress and level of preparation needed to use the MMIS to adjudicate claims
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Monitor operations reports, prepare reports to account for unit activities as assigned, assist management with report monitoring, analysis, and generation activities
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Facilitate transitions between systems and added enhancements. Facilitate transitions between Medicaid claims processing systems and subsequent enhancements. Research and define policy and operational differences between systems/system enhancements
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Knowledge of health care claims operations, processes, and procedures
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Knowledge of private third-party liability and Medicare payments
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Ability to navigate multiple software applications, databases, multiple screens and data entry
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Customer service skills sufficient to interact with a wide variety of customers in a professional manner
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Basic math skills sufficient to add, subtract, multiply or divide correctly
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Knowledge of medical terminology/coding
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Strong communication skills sufficient to communicate clearly to both technical and non-technical clientele
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Knowledge of the screening documents, medical and home care prior authorization forms, and waiver service agreements forms, and associated coding structures
- understanding of the MMIS large scale claims processing systems as it relates to the review, correction, acceptance and/or denial, and processing of claims and other forms
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Understanding of and ability to use Electronic Data Processing concepts and terminology
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Thorough understanding of the MMIS large scale claims processing systems as it relates to the review, correction, acceptance and/or denial, and processing of claims and other forms
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Variety of experiences working effectively with others from different backgrounds and cultures
To facilitate proper crediting, 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.
This position requires successful completion of the following:
It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:
Criminal background check
Reference check
Fingerprinting check (MNJIS/CJIS)
Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3 business days from the start of employment; and successfully obtain/retain CJIS certification annually.
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 [email protected]. For additional information about the application process, go to http://www.mn.gov/careers.
If you have questions about the position, contact Denise Nelson at
[email protected].
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 JaKeya Spencer at [email protected].
If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 or [email protected] for assistance.
WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.
What do Minnesota's State employees have in common?
- A sense of purpose in their work
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Connection with their coworkers and communities
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Opportunities for personal and professional growth
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.
- Paid vacation and sick leave
- 12 paid holidays each year
- Low-cost medical, dental, vision, and prescription drug plans
- Fertility care, including IVF
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Diabetes care
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Dental and orthodontic care for adults and children
- 6 weeks paid leave for parents of newborn or newly adopted children
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Pension plan that provides income when you retire (after working at least three years)
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Employer paid life insurance to provide support for your family in the event of death
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Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
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Tax-free expense accounts for health, dental, and dependent care
- Resources that provide support and promote physical, emotional, social, and financial well-being
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Training, classes, and professional development
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Tuition reimbursement
- 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)
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A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
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Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
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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 [email protected] and let us know the support you need.
