HIPP Operations Specialist

Commonwealth of Pennsylvania; New Stanton (Westmoreland County); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Telework up to 3 days per week

Free parking

Job summary

The Commonwealth of Pennsylvania's Department of Human Services is seeking a HIPP Operations Specialist to evaluate insurance coverage, determine program eligibility, and connect participants with health insurance benefits across Pennsylvania.

Responsibilities include reviewing policies, coordinating with employers, monitoring eligibility, case management, and telework opportunities up to three days per week; standard hours 8:00 AM–4:00 PM, Monday–Friday, with free parking.

Qualifications

• One year of experience as a Third Party Liability or Medical Assistance Program Technician or equivalent.
• Four years of experience in review and analysis of medical insurance policies and premiums.
• Any equivalent combination of experience and training.

Responsibilities

• Program Inquiries: Respond to telephone and written inquiries, explain HIPP processes, and provide information about enrollment, claims, and premium payment procedures.
• Insurance Analysis: Review health insurance policies and benefit information, evaluate available coverage, compare costs, and determine program eligibility.
• Case Management: Maintain enrolled cases, conduct cost effectiveness reviews, resolve status issues, process overpayments, and prepare discontinuance notices when appropriate.
• Medical Assistance for Workers with Disabilities Coordination: Contact employers, arrange payment processes, evaluate employer health plan eligibility, and negotiate enrollment for qualified participants.
• Breast and Cervical Cancer Prevention and Treatment Reviews: Process referrals, determine credible coverage requirements, and respond within established timeframes.
• Operational Support: Prepare correspondence, maintain program databases, attend training sessions, and collaborate with departmental units to support efficient program operations.

Job description

Are you skilled at analyzing health insurance information and finding cost-effective solutions that support important public programs? As a HIPP Operations Specialist with the Department of Human Services, you will evaluate insurance coverage, determine program eligibility, and help connect participants with valuable health insurance benefits. Your work will support efficient program operations while assisting individuals and families across Pennsylvania. Apply your analytical talents in a position that delivers meaningful results every day.

This position supports the Health Insurance Premium Payment (HIPP) program by determining cost effectiveness, enrolling eligible participants, maintaining active cases, and responding to program inquiries. Responsibilities include reviewing insurance information, coordinating with employers and agencies, monitoring eligibility, and supporting efficient program operations. As a HIPP Operations Specialist, you will perform the following duties:

• Program Inquiries: Respond to telephone and written inquiries, explain HIPP processes, and provide information about enrollment, claims, and premium payment procedures
• Insurance Analysis: Review health insurance policies and benefit information, evaluate available coverage, compare costs, and determine program eligibility
• Case Management: Maintain enrolled cases, conduct cost effectiveness reviews, resolve status issues, process overpayments, and prepare discontinuance notices when appropriate
• Medical Assistance for Workers with Disabilities Coordination: Contact employers, arrange payment processes, evaluate employer health plan eligibility, and negotiate enrollment for qualified participants
• Breast and Cervical Cancer Prevention and Treatment Reviews: Process referrals, determine credible coverage requirements, and respond within established timeframes
• Operational Support: Prepare correspondence, maintain program databases, attend training sessions, and collaborate with departmental units to support efficient program operations

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Free parking is included with this position.
• Telework: You may have the opportunity to work from home (telework) part-time, up to three days per 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 Torrance. The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• 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.

QUALIFICATIONS

Minimum Experience and Training Requirements

• One year of experience as a Third Party Liability or Medical Assistance Program Technician (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); or
• Four years of experience in the review and analysis of medical insurance policies and premiums, reviewing and responding to inquiries relating to applicable service or benefits in health care insurance programs, health care services or Medical Assistance program services; or
• Any equivalent combination of experience and training.

Other Requirements

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

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.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

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.

• 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/test once for this posting.
• Your results will be provided via email.