Third Party Liability Program InvestigatorPrint (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4473152) ApplyThird Party Liability Program InvestigatorSalary$47,472.00 - $72,176.00 AnnuallyLocation Dauphin County, PAJob TypeCivil Service Permanent Full-TimeJob NumberCS-2024-82264-39680DepartmentDepartment of Human ServicesDivisionHS Div Third Prty LiabOpening Date04/22/2024Closing Date5/6/2024 11:59 PM EasternJob Code39680Position Number50461303UnionFOPBargaining UnitG4Pay GroupST06Bureau / Division Code00211793Bureau / DivisionBureau of Program Integrity/Third Party Liability/ Recovery SectionWorksite Address303 Walnut StreetWorksite AddressCommonwealth Tower, 7th FloorCityHarrisburg, PennsylvaniaZip Code17101Contact NameRicki PadenContact Phone717.772.6760Contact [email protected]
Description
Benefits
Questions
THE POSITIONA new and exciting career awaits you! If you enjoy investigative and recovery work, the Department of Human Services (DHS), Division of Third Party Liability in the Bureau of Program Integrity, has an opportunity for you! We are searching for a Third Party Liability Program Investigator to join their team. If you are a motivated individual and feel this would be the job for you, don't delay, apply today! DESCRIPTION OF WORKIn this position, you will recover medical assistance expenditures that were incorrectly or provisionally paid on behalf of DHS benefit recipients. You will work in conjunction with other department units as well as the Office of the Inspector General to review and analyze referrals received from county assistance offices, medical providers, attorneys, insurance carriers, probate estates, other Commonwealth agencies to determine if DHS benefits were inappropriately granted, and to identify the responsible obligor. You will negotiate settlements by using sound judgment and skilled diplomacy in order to maximize collections and maintain the best interest of the department. You will r eview payments received and resolve any discrepancies, as well as process payment notices accurately. This is a role which requires the use of sound verbal and written communication skills in order to effectively outline the department's clams and to defend the department position if necessary, which may include testifying in hearings and court appearances. Interested in learning more? Additional details regarding this position can be found in the position description (https://careers.employment.pa.gov/pd/PDNEOGOV.asp?p=50461303) .Work Schedule and Additional Information:
Full-time employment, 37.5 hours per week
Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with 30-minute lunch.
Telework: You may have the opportunity to work from home (telework) part-time up to 3 days a week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
Free parking!
Salary: In some cases, the starting salary may be non-negotiable.
You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.
REQUIRED EXPERIENCE, TRAINING & ELIGIBILITYQUALIFICATIONS Minimum Experience and Training Requirements:
Four years of experience in the investigation of Health Care and personal injury records, correspondence and documents used in establishing legal liability, or determining approval of health care and personal injury insurance claims; or
One year of experience as a Third Party Liability Program Technician;or
Any equivalent combination of experience and training.
Other Requirements:
You must meet the PA residency requirement (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . For more information on ways to meet PA residency requirements, follow the link (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) and click on Residency.
You must be able to perform essential job functions.
How to Apply:
Resumes, cover letters, and similar documents willnotbe reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
Failure to comply with the above application requirements may eliminate you from consideration for this position.
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 [email protected] .
Telecommunications Relay Service (TRS):
711 (hearing and speech disabilities or other individuals).
If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply. EXAMINATION INFORMATION
Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
Your score is valid for this specific posting only.
You must provide complete and accurate information or:
your score may be lower than deserved.
you may be disqualified.
You may only apply/testoncefor this posting.
Your results will be provided via email.
Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) !Health & WellnessWe offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.Compensation & Financial PlanningWe invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options. Work/Life BalanceWe know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities. Values and CultureWe believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.Employee PerksSometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.For more information on all of these Total Rewards benefits, please visitwww.employment.pa.gov and click on the benefits box.Eligibility rules apply.01 Have you been employed by the Commonwealth of Pennsylvania as a Third Party Liability Program Technician for one or more years full-time?
Yes
No
02
If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
03
How many years of full-time experience do you possess in the investigation of health care and personal injury records, correspondence and documents used in establishing legal liability, or determining approval of health care and personal injury insurance claims?
4 years or more
2 to 3 years
1 year
No Experience
04
If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
05
Do you possess any of the below degrees in Pre-law, Criminal Justice, Police Science, Political Science, Health Care, Public Health, Health Care Administration, or Health Care Technician fields?
If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.If your education was acquired outside of the United States, you must also upload a copy of your foreign credential evaluation. For more information on foreign education credentials, please visithttps://www.employment.pa.gov/Additional%20Info/Pages/default.aspx#q3and click on Other Information.
Master's Degree
Bachelor's Degree
Associate's Degree
No Degree
06
You must complete the supplemental questions below. These supplemental questions are the exam and will be scored. They are designed to give you the opportunity to relate your experience and training background to the major activities (Work Behaviors) performed in this position. Failure to provide complete and accurate information may delay the processing of your application, or result in a lower-than-deserved score or disqualification. Youmustcomplete the applicationandanswer the supplemental questions. Resumes, cover letters, and similar documents will not be reviewed for the purposes of determining your eligibility for the position or to determine your score.
All information you provide on your application and supplemental questions is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. If requested, you must provide documentation, including names, addresses, and telephone numbers of individuals who can verify the validity of the information you provide in the application and supplemental questions.Read each work behavior carefully. Determine and select which "Level of Performance" most closely represents your highest level of experience/training. List the employer(s)/training source(s) from your Work or Education sections of the application where you gained this experience/training.The "Level of Performance" you choose for each work behavior must be clearly supported within the description of the experience and training information entered in your application or your score may be lowered.In order to receive credit for experience, you must have worked in a job for at least six months in which the experience claimed was a major function.If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.If you have general questions regarding the application and hiring process, please refer to ourFAQ page (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) .
Yes
07
WORK BEHAVIOR 1 – REVIEWS, EVALUATES AND ANALYZES NEW CASE REFERRALS AND DOCUMENTS
Reviews, evaluates and analyzes new case referrals and documentation completed by medical assistance recipients involved in personal injury accidents and for medical assistance recipients' estates to determine validity, the nature of the incident, participants involved (heir, attorney, executor, insurer, defendant, etc.), dates, description of medical injuries and treatments provided, sources of medical treatment, insurance coverage, and representing attorneys and possible legal actions, if applicable.Levels of PerformanceSelect the "Level of Performance" which best describes your claim.
A. I have experience reviewing, evaluating and analyzing new case referrals and documentation completed by medical assistance recipients involved in personal injury accidents AND medical assistance recipients' estates to determine validity, the nature of the incident, participants involved (heir, attorney, executor, insurer, defendant, etc.), dates, description of medical injuries and treatments provided, sources of medical treatment, insurance coverage, and representing attorneys and possible legal actions, if applicable.
B. I have experience reviewing, evaluating and analyzing new case referrals and documentation completed by medical assistance recipients involved in personal injury accidents OR for medical assistance recipients' estates to determine validity, the nature of the incident, participants involved (heir, attorney, executor, insurer, defendant, etc.), dates, description of medical injuries and treatments provided, sources of medical treatment, insurance coverage, and representing attorneys and possible legal actions, if applicable.
C. I have experience reviewing, evaluating and analyzing new case referrals and documentation to determine validity, the nature of the incident, participants involved (heir, attorney, executor, insurer, defendant, etc.), dates, and representing attorneys and possible legal actions, if applicable. This experience was not related to medical assistance recipients' personal injury or their estates.
D. I have successfully completed college-level coursework related to this work behavior.
E. I have NO experience or training related to this work behavior.
08
In the text box below, please describe your experience as it relates to the level of performance you claimed on this work behavior. Please be sure your response addresses the items listed below. If you indicated you have no work experience related to this work behavior, type N/A in the box below.
The name(s) of the employer(s) where you gained this experience.
The actual duties you performed related to reviewing, evaluating, and/or analyzing new case referrals and documentation.
The type(s) of documentation you reviewed, evaluated, and/or analyzed.
Your level of responsibility.
09
If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.
College/University
Course Title
Credits/Clock Hours
10
WORK BEHAVIOR 2 – INVESTIGATES PERSONAL INJURY CLAIMS AND THEIR ESTATES
Investigates medical assistance recipients' personal injury claims and their estates by collecting and analyzing claim, asset and expenditure information, and by researching, interpreting and analyzing Public Welfare code, applicable Federal and State regulations and statutes, insurance laws and regulations, probate codes, and specific policy coverage in order to identify third parties or other resources available to recover payment for medical services provided to individuals as a result of a personal injury or as part of an estate recovery and determine the appropriate actions to collect recoverable provided benefits.Levels of PerformanceSelect the "Level of Performance" which best describes your claim.
A. I have experience investigating medical assistance recipients' personal injury claims AND their estates by collecting and analyzing claim, asset and expenditure information, and by researching, interpreting and analyzing Public Welfare code, applicable Federal and State regulations and statutes, insurance laws and regulations, probate codes, and specific policy coverage in order to identify third parties or other resources available to recover payment for medical services provided to individuals as a result of a personal injury or as part of an estate recovery and determine the appropriate actions to collect recoverable provided benefits.
B. I have experience investigating medical assistance recipients' personal injury claims OR their estates by collecting and analyzing claim, asset and expenditure information, and by researching, interpreting and analyzing Public Welfare code, applicable Federal and State regulations and statutes, insurance laws and regulations, probate codes, and specific policy coverage in order to identify third parties or other resources available to recover payment for medical services provided to individuals as a result of a personal injury or as part of an estate recovery and determine the appropriate actions to collect recoverable provided benefits.
C. I have experience conducting investigations not related to medical assistance recipients' personal injury or their estates.
D. I have successfully completed college-level coursework related to this work behavior.
E. I have NO experience or training related to this
11
In the text box below, please describe your experience as it relates to the level of performance you claimed on this work behavior. Please be sure your response addresses the items listed below. If you indicated you have no work experience related to this work behavior, type N/A in the box below.
The name(s) of the employer(s) where you gained this experience.
The actual duties you performed related to conducting investigations.
The type(s) of investigations you have conducted.
Your level of responsibility.
12
If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.
College/University
Course Title
Credits/Clock Hours
13
WORK BEHAVIOR 3 – COMMUNICATION
Communicates orally and through written communications with attorneys, insurance companies, executors, and title companies in order to determine if another party is liable for reimbursement of medical/cash assistance relating to personal injury and estate recovery claims, or if there is pending litigation, a lawsuit settlement, or award as a result of personal injury or death.Levels of PerformanceSelect the "Level of Performance" which best describes your claim.
A. I have experience communicating orally and through written communications with all of the following parties: attorneys, insurance companies, executors, and title companies in order to determine if another party is liable for reimbursement of medical/cash assistance relating to personal injury and estate recovery claims, or if there is pending litigation, a lawsuit settlement, or award as a result of personal injury or death.
B. I have experience communicating orally and through written communications with 2 of the following parties: attorneys, insurance companies, executors, and title companies in order to determine if another party is liable for reimbursement relating to personal injury and estate recovery claims, or if there is pending litigation, a lawsuit settlement, or award as a result of personal injury or death.
C. I have experience communicating orally and through written communications in order to determine if another party is liable, if there is pending litigation, a lawsuit settlement, etc. not related to personal injury or estate recovery claims.
D. I have successfully completed college-level coursework related to this work behavior.
E. I have NO experience
14
In the text box below, please describe your experience as it relates to the level of performance you claimed on this work behavior. Please be sure your response addresses the items listed below. If you indicated you have no work experience related to this work behavior, type N/A in the box below.
The name(s) of the employer(s) where you gained this experience.
The actual duties you performed related to oral and written communications and with whom (i.e., attorneys, insurance companies, executors, title companies).
Your level of responsibility.
15
If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.
College/University
Course Title
Credits/Clock Hours
16
WORK BEHAVIOR 4 – PROVIDES ASSISTANCE AND GUIDANCE
Provides assistance and guidance regarding personal injury and estate recovery issues to service providers, insurers, attorneys and other interested parties.Levels of PerformanceSelect the "Level of Performance" which best describes your claim.
A. I have experience providing assistance and guidance regarding personal injury AND estate recovery issues to service providers, insurers, attorneys and other interested parties.
B. I have experience providing assistance and guidance regarding personal injury OR estate recovery issues to service providers, insurers, attorneys and other interested parties.
C. I have experience providing assistance and guidance to individuals regarding issues not related to personal injury or estate recovery issues.
D. I have successfully completed college-level coursework related to this work behavior.
E. I have NO experience or training related to this work behavior.
17
In the text box below, please describe your experience as it relates to the level of performance you claimed on this work behavior. Please be sure your response addresses the items listed below. If you indicated you have no work experience related to this work behavior, type N/A in the box below.
The name(s) of the employer(s) where you gained this experience.
The actual duties you performed related to providing guidance and assistance and for what reason.
Your level of responsibility.
18
If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.
College/University
Course Title
Credits/Clock Hours
19
WORK BEHAVIOR 5 – NEGOTIATES REIMBURSEMENTS AND REVIEWS PAYMENTS
Negotiates reimbursement of medical and cash claims with recipients, third parties or legal professionals in order to secure financial settlements; and reviews payments received in order to resolve discrepancies with the liable party prior to processing payment.Levels of PerformanceSelect the "Level of Performance" which best describes your claim.
A. I have experience negotiating reimbursement of medical and cash claims with recipients, third parties or legal professionals in order to secure financial settlements; AND reviewing payments received in order to resolve discrepancies with the liable party prior to processing payment.
B. I have experience negotiating reimbursement of medical and cash claims with recipients, third parties or legal professionals in order to secure financial settlements; OR I have reviewed payments received in order to resolve discrepancies with the liable party prior to processing payment.
C. I have experience conducting negotiations not related to reimbursement of medical and cash claims.
D. I have successfully completed college-level coursework related to this work behavior.
E. I have NO experience or training related to this work behavior.
20
In the text box below, please describe your experience as it relates to the level of performance you claimed on this work behavior. Please be sure your response addresses the items listed below. If you indicated you have no work experience related to this work behavior, type N/A in the box below.
The name(s) of the employer(s) where you gained this experience.
The actual duties you performed related to negotiating reimbursements and/or reviewing payments.
Your level of responsibility.
21
If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.
College/University
Course Title
Credits/Clock Hours
Required Question
AgencyCommonwealth of PennsylvaniaAddress613 North StreetHarrisburg, Pennsylvania, 17120Websitehttp://www.employment.pa.gov