Program Specialist - Recovery and Cost Avoidance

State of Nebraska; Lincoln (NE); On-site; USD 28,000 - 40,000; Full time

Job summary

The State of Nebraska, Health & Human Services – Agency 25 in Lincoln, seeks a Program Specialist for Recovery and Cost Avoidance to help Medicaid maximize funds and reduce costs while ensuring members get needed healthcare and support.

You will work with clients, providers, and staff to coordinate benefits, review insurance plans, verify reimbursements, and develop program policies in a collaborative environment.

Qualifications

• Experience with medical claims/insurance claim coordination and medical office administration.
• Experience reading/interpreting insurance policies.

Responsibilities

• Review health insurance benefit plans, explanations of benefits, and claims history; verify, approve and issue reimbursements.
• Plan, coordinate, develop, administer and evaluate statewide health and human services programs.
• Provide technical assistance/advice to agency staff, clients and service providers; act as a resource.
• Research and develop program policy and perform QA analysis and evaluation of assigned programs.

Skills

Medical claims coordination

Insurance policy interpretation

Medical office administration

Education

Bachelor’s degree in social sciences or related field

Job description

Job Posting

JR2026-00028537 Program Specialist - Recovery and Cost Avoidance (Open)

The work we do matters!

Hiring Agency

Health & Human Services - Agency 25

Location

Lincoln, NE

Hiring Rate

$24.862

Applications No Longer Accepted On

(If no date is displayed, job is posted as open until closed):

08-20-2026

Job Description

Are you interested in helping Medicaid maximize funds and reduce Medicaid costs while working to ensure members get needed healthcare and support? State And Federal Law Requires Medicaid To Be The Payer Of Last Resort. The Recover And Cost Avoidance (RCA) Unit Works With Clients, Providers, Attorneys, Insurers, And Others To Reduce The Cost Of Medicaid To Citizens Of The State Of Nebraska. We Accomplish This Through Four Separate Programs Designed To Support This Aim Coordination of Benefits (COB): This team adds, verifies and maintains health insurance information of all Medicaid-eligible clients; allowing claims to process and pay timely. They also work with private Long-Term Care (LTC) insurers of Medicaid eligible clients to cover the client’ LTC services. This team cost avoided $2.7 million in total funds SFY2026. Estate Recovery (ER): This team is responsible for pursuing and recovering eligible Medicaid payments when assets exist after a client passes away. This team recovered $8.9 million in total funds in SFY2026. Health Insurance Premium Payment Program (HIPP): The HIPP program pays for health insurance premiums of Medicaid-eligible individuals if it is cost-effective for the State. If it costs Medicaid less to cover the equivalent set of services through the private health plan, then it is considered cost-effective. This team cost-avoided $4.7 Million in SFY2026. Third Party Liability /Casualty (TPL): This team is responsible for ensuring Medicaid is the payer of last resort on all fee-for-service casualty and health claims when liability exists by other parties or insurance companies. This team recovered and cost avoided approximately $3.7 Million in SFY2026 Be a member of a team committed to improving efficiencies and tackling goals that support the Nebraska Medicaid mission to Help people live better lives. 'You have the passion; we have the opportunities - let's make a difference for Nebraskans!'

Examples Of Work

A Program Specialist on the RCA team will have opportunity to:

• Review of health insurance benefit plans, explanation of benefits and medical and pharmacy claims history, financial and payment documentation, as well as verifying, approving and issuing reimbursements
• Plan and coordinate the development, administration and evaluation of statewide health and human services program(s)
• Serve as a resource and consultant to provide technical assistance/advice to agency staff, clients and service providers
• Research and develop program policy and perform quality assurance analysis and evaluation of assigned program(s)
• Perform related duties as assigned

Hire Rate: $24.862 per hour – non-exempt

Work Schedule: 40 hours per week. Monday – Friday; 8:00 AM – 5:00 PM

Dress Attire: Business Casual

Location: Nebraska State Office Building – Lincoln

Preferred Qualifications

• A bachelor’s degree in social sciences, education, or a related field is preferred.
• Experience with medical claims/insurance claim coordination, medical office administration.
• Experience reading/interpreting insurance policies.

Knowledge, Skills, And Abilities

Knowledge of:

the principles and practices of public administration; procedure and policy development; methods and techniques of program planning; federal and state laws, rules, regulations and procedures pertaining to health and human services programs; public funds and budgeting methods; the principles and techniques of adult learning; quality assurance mechanisms; principles and techniques of planning, monitoring and evaluating human services programs and service delivery systems.

Skill in:

interpreting and/or clarifying policy to interested groups; conducting formal presentations to provide education and share information.

Ability to:

plan, organize and direct a major program; work collaboratively in a team setting; analyze, develop and organize materials; establish and maintain positive relationships with agency staff, service providers/contractors, community organizations and clients; communicate electronically, on paper or in person to promote, explain, discuss, advise and interact with interested groups on various program issues and problems; prepare and review technical documents such as summaries of state and federal regulations, action plans, reports, contracts and grants; understand, interpret and apply instructions, laws, rules, policies and procedures pertinent to the program; exercise independent critical thinking skills; maintain liaison with community representatives and other governmental agencies.

Benefits

We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation. Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits

Equal Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.