Medical Claims Coordinator

State of Nebraska•Lincoln, NE

40d•$21•Onsite

About The Position

We’re seeking candidates who bring a strong attention to detail and a commitment to accuracy, along with the ability to work effectively in a structured, fast-paced environment. Join Our Team! Are you looking for a workplace where your attention to detail, passion for helping others, and love for teamwork are valued and make a difference every day? Join our dedicated team at the Department of Health and Human Services as a Medical Claims Coordinator in our Medicaid and Long-Term Care Claims Division. We are committed to service, collaboration, and making an impact on the lives of Nebraskans — and we like to have a little fun along the way! As a Medical Claims Coordinator for the Recovery and Cost Avoidance team you’ll play a vital role in ensuring Medicaid appropriately remains the payor of last resort for health and casualty claims. This detail-oriented role involves investigating the circumstances surrounding health claims when there is indication that payment for the claim may be obtained from sources other than Title XIX Medicaid funds.

Requirements

Bachelor’s degree in business administration, management, public administration, accounting, behavioral sciences, or a closely related field AND one year of investigative research experience OR five years’ continued education and/or experience in a field such as public or business administration, accounting, or any discipline related to the work assigned.
Any equivalent combination of education and experience will be considered.
Customer Service Skills – Ability to communicate clearly, listen actively, and handle questions or complaints with professionalism.
Attention to Detail – Able to review forms and data accurately to catch errors or missing information.
Computer Proficiency – Comfortable using Microsoft Office (Word, Excel, Outlook) and navigating multiple computer systems.
Time Management – Capable of handling a high volume of work, staying organized, and meeting deadlines.
Problem-Solving – Able to identify issues, think critically, and find practical solutions for customers or internal processes.
Communication Skills – Strong written and verbal communication to explain processes, respond to inquiries, and document work.
Teamwork – Willing to work cooperatively with others and assist team members when needed.
Adaptability – Able to learn new systems, take on different tasks, and adjust to changes in a fast-paced environment.
Confidentiality Awareness – Understands and follows privacy regulations like HIPAA when handling sensitive information.

Nice To Haves

Experience with health insurance terminology/processes, Microsoft Office (Excel, Word, Outlook, etc.) databases, Medicaid Claims Processing, and Medicaid eligibility.
Experience with C1/MMIS, N-FOCUS, and OnBase would be beneficial.
Strong analytical and problem-solving skills, including the ability to interpret and apply regulations, identify discrepancies, and recommend appropriate actions.
A professional, customer-focused approach when communicating with providers, clients, business partners and internal team members.
Comfort using multiple computer systems and databases to research, update, verify and manage insurance related information efficiently.

Responsibilities

Answer and direct calls placed or referred to the Coordination of Benefits /Casualty call line.
Analyze claims for payor accuracy, investigate and resolve liability issues, and ensure compliance with Medicaid policies and procedures.
Communicate with team members to address claim inquiries and support both internal teams and external partners.
Initiate research and bring resolution to processed claims which may have been processed and paid and now need to be recouped and billed to a liable third-party resource.
Research extent and sources of third-party liability for medical claims payment and ensure these payments are fully utilized.
Perform Third Party verifications and accurately enter the findings into a database.
Collaborate with appropriate program staff to report and follow-up if fraud, waste or abuse activities are identified.
Perform related work as assigned.

Benefits

State-matched retirement contribution of 156%!
13 paid holidays
Generous leave accruals that begin immediately
Tuition reimbursement program
79% employer-paid health insurance plans
Dental and vision insurance plans
Employer-paid $20,000 life insurance policy
Career advancement opportunities as the largest and most diverse employer in the state
Training and development based on your career goals
Employee Assistance Program