Claims Research Manager

Kansas Department of Health and Environment; Kansas; Presencial; USD 30.000 - 34.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive medical, dental, vision

Paid state holidays

Retirement and deferred compensation

Descripción de la vacante

Kansas Department of Health and Environment seeks a Claims Research Manager (K0222608) to oversee claims processing, guidance on submission of claims and encounter data, and work with contractors to ensure compliance with state and federal rules.

This regular, full-time role requires auditing, data review, and coordination across KDHE teams to remediate issues and improve performance.

Formación

• Minimum one year of experience in government programs/health care or health insurance such as Medicaid, Medicare or commercial insurance industry.
• Preferred experience includes filing or billing Medicaid or commercial insurance claims, or processing applications.
• Valid Driver's License required to operate a state vehicle or company vehicle.

Responsabilidades

• Attend entrance/exit conferences and other meetings with auditors.
• Review and respond to audit findings and track all findings.
• Perform reviews of Fee for Service claims and encounter data to ensure federal requirements are met.

Conocimientos

Government programs

Claims processing

Educación

High School, GED

Descripción del empleo

Job Posting

Important Recruitment Information for this vacancy

Job Posting closes: October 25, 2026

Required documents uploaded by: October 25, 2026

Kansas Department of Health and Environment: Our agency is led by Secretary Janet Stanek, who was appointed by Gov. Kelly in Dec 2021. KDHE is comprised of three divisions: Public Health, Environment, and Health Care Finance (which includes the State’s Medicaid program, KanCare). We are the only agency in the nation to have these three entities under one roof which allows us to take a holistic approach to improving and protecting the health and well-being of all Kansans.

Verification of identity and employment eligibility to work in the United States is required by federal law. For a list of acceptable documents that establish these criteria, please refer to the federal Form I-9 . KDHE does not provide sponsorships for this position.

If you are a OPT or STEM OPT applicant, please note that all individuals must maintain valid employment authorization and an unexpired EAD.

E-Verify: Kansas Department of Health and Environment (KDHE) participates in E-Verify and will provide the federal government with your I-9 information to confirm that you are authorized to work in the U.S. For additional information regarding Immigrant and Employee Rights (IER) we do not provide a link here.

http://www.kdhe.ks.gov/

About The Position

• Who can apply: Anyone (External).
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits: Yes
• Veterans' Preference Eligible: Yes
• Sponsorship: KDHE does not provide sponsorship for this position.

Compensation

• Hourly Pay Range: $22.38 - $24.72
• Salary can vary depending upon education, experience, or qualifications.

Employment Benefits

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement And Deferred Compensation Programs

Visit the Employee Benefits page for more information…

Position Summary & Responsibilities

The Claims Research Manager position (K0222608) manages Oversight and Compliance Monitoring, provides guidance and direction on the submission of claims and encounter data processing between contractors. This includes performing reviews of managed care claims and encounter data activities to ensure that all contract (state and federal) requirements are met; tracking and managing all findings and observations resulting from the review; and reviewing reports to ensure claims and encounter data are valid, accurate, complete, submitted timely, and in compliance with state and federal regulations. The position also attends, participates in, or facilitates various meetings involving claims processing or encounter data; reviews publications and contracts as necessary; and works with contractors on remediation or corrective action plans when necessary. Additionally, the position reviews processes to ensure they are in compliance with their contract, including but not limited to front end billing, directs activities related to the management of claims, corrected claims, claims reprocessing, and encounter claims inventory, and works with KDHE, sister agencies, or KDHE contractors in monitoring contractors.

Job Responsibilities may include but are not limited to the following:

• Attend entrance/exit conferences and other meetings (as needed) with auditors.
• Review and respond to audit findings as well as track and report all findings.
• Perform reviews of Fee for Service claims and encounter data activities to ensure that all federal requirements are met.

Qualifications

• Education:
  • High School, GED
  • Education may be substituted for experience as determined relevant by the agency.
• Licensing & Certification:
  • Valid Driver's License - Incumbent is required to have and maintain a valid driver's license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.
• Minimum Qualifications:
  • One year of experience working in government programs/health care or health insurance such as Medicaid, Medicare or commercial insurance industry. Experience preferred includes filing or billing Medicaid or commercial insurance claims, or processing applications.
• Preferred Qualifications:
  • Word, Excel, PowerPoint, Access
  • Proofreading, editing, attention to detail
  • General knowledge of federal and state laws and regulations regarding health insurance claims.
  • Ability to conduct formal presentations or negotiate and persuade to settle issues.
  • Advanced problem solving and analytical skills
  • Experience in providing Customer Service
  • Ability to interpret and apply policies affecting agency program operations.
  • Ability to gather relevant information and ability to provide concise and accurate reports.
• Post-Offer, Pre-employment Requirements:
  • Kansas Tax Clearance Certificate: A valid Kansas Tax Clearance Certificate is a condition of employment for all employees of the State of Kansas. Applicants (including non-residents) who receive a formal job offer for a state job, are required to obtain a valid Tax Clearance within ten (10) days of the job offer. A Tax Clearance can be obtained through the Kansas Department of Revenue who reviews individual accounts for compliance with Kansas Tax Law. If you have a missing tax return(s) or you owe taxes to the State of Kansas, please know that the Kansas Department of Revenue will work with you. The Kansas Department of Revenue can set you up on a payment plan to receive a Tax Clearance so you can get a job working for the State of Kansas. The Kansas Department of Revenue can be contacted at 785-296-3199. Kansas Department of Revenue - Tax Clearance Frequently Asked Questions

Equal Employment Opportunity

The State of Kansas is an Equal Opportunity Employer. We value diversity, equity, and inclusion as essential elements that create and foster a welcoming workplace. All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.

If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the agency recruiter.