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Tort & Casualty Specialist
Department Information
STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION
NOTE: This announcement may be used to fill multiple openings.
Envision yourself working at HCPF
The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
As part of the State of Colorado, HCPF offers a competitive benefits package:
- PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
- Medical, Dental, and Vision insurance coverage
- Automatic Short-Term and Optional Long-Term Disability Coverage
- Life and AD&D Insurance
- Flexible Spending Accounts (FSAs)
- Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
- 11 Paid Holidays Annually and Accrued Annual and Sick Leave
- Accrued Sick Leave for State of Colorado Temporary Employees
- Flexplace and Flextime work arrangements
- Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
- Free RTD EcoPass to all eligible State Employees
- Credit Union of Colorado Membership Eligibility
- Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs
We are looking for a Tort & Casualty Specialist to join our Third-Party Liability & Recoveries team!
The Third-Party Liability & Recoveries function ensures that Medicaid dollars are spent appropriately and in compliance with state and federal regulations. The Section's purpose is to pursue third party payment of medical costs for Medicaid eligible clients to expand purchasing power for public benefits.
Methods used include: (1) avoid costs where appropriate by identifying third party payers and directing claims to them for payment, (2) recover medical payments from liable third parties where it is not possible to deny or divert claims, (3) identify areas of waste such as eliminating funding of Medicaid to ineligible individuals.
We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.
**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**
Description of Job
This position recovers Medicaid dollars spent on behalf of clients when another party is liable for the costs.
WHAT YOU'LL BE DOING AS TORT & CASUALTY SPECIALIST:
- In the context of tort & casualty cases, evaluates referrals from clients, attorneys, property & casualty carriers, medical malpractice carriers, and mass tort lien administrators to determine whether Medicaid may have a lien for any medical assistance that should be borne by the at fault party.
- Analyzing claims in the case management system and comparing the treatment rendered to the nature of the injury or incident to determine whether the Department may have a lien. Following this claim analysis, communicates with parties to provide the report of Medicaid’s expenditures if treatment is identified that is related to the incident or accident.
- Identifies criminal cases with potential recoveries by responding to state district attorneys in cases where Medicaid may be entitled to restitution. In these cases, the Medicaid client may have been injured as a result of criminal conduct. The Department is entitled to restitution considering its status as a potential victim. Evaluates claims to determine whether Medicaid paid for treatment that should be borne by the defendant. Pursuing restitution entails working with district attorneys, victim coordinators, and representing the Department in court.
- Monitors cases to ensure that settlements are not disbursed prior to Medicaid recouping its lien. Periodic monitoring of cases ensures that lien totals are up-to-date, and the unit is apprised of any changes in the case and tracks the case as the personal injury attorney brings the case to a conclusion. The expected volume of cases is approximately 600 to 700 at any given time.
- Monitors cases to ensure counsel is making adequate efforts to recover the Medicaid lien. Determines whether referral of the case to the AGO is necessary to protect the Department’s lien.
- Negotiates settlements in personal injury cases based on facts and the legal strengths of the case. Position also drafts letters to counsel informing them of the Department’s calculation of the Medicaid lien. For example, at the appropriate point in the litigation timeline determined by the rules of civil procedure and the orders of court, the position will be contacted by the Medicaid recipient’s counsel to inform the Department of any pending settlement offers or the timing of a settlement conference.
- Attends in person or by telephone at those conferences and mediations involving significant lien amounts and using the guidance established by the unit’s procedures and the position’s discretion whether to attend mediation.
- Other duties as assigned.
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
RESIDENCY REQUIREMENT:
This posting is only open to residents of the State of Colorado at the time of submitting your application.
CLASS CODE & CLASSIFICATION DESCRIPTION:
H1B3XX
ADMINISTRATOR III
MINIMUM QUALIFICATIONS:
Experience Only:
Six (6) years of professional experience in medical claims analysis, working with personal injury claims; or negotiating settlements.
OR
Education and Experience:
A bachelor's degree from an accredited institution in Health Policy, Health Administration, Business Administration or a field of study related to the work assignment; and two (2) years of professional experience in medical claims analysis, working with personal injury claims; or negotiating settlements.
Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:
- An associate will count as two years of experience.
- A bachelors will count as four years of experience.
- A masters degree will count for six years of experience.
- A doctorate or juris doctorate degree will count for seven years of experience.
Note: Per the Job Application Fairness Act (Download PDF reader), you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.
PREFERRED QUALIFICATIONS:
- Prior state experience related to the duties of this position
- Experience in financial recoveries on behalf of individuals when another party is liable for the costs
- Experience working in a claims system or other similar information technology platform and creating and using spreadsheets to analyze data such as Microsoft Excel
- Experience negotiating as well as resolving disputes with adverse parties
- Experience with soliciting advice of counsel
- Experience applying the facts of a case to a law, rule, or guideline and clearly articulating one’s rationale
DEFINITION OF PROFESSIONAL EXPERIENCE:
Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
CONDITIONS OF EMPLOYMENT:
- All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
- Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
APPEAL RIGHTS:
An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.
As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.
Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.
For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, atspb.colorado.gov/board-rules.
Supplemental Information
How to Apply (PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations:
The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Minnie Kaur, at anupreet.kaur@state.co.us.
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.
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