LEOFF-1 Medical Claims Specialist

King County   Seattle, WA   Full-time     Health Care Provider
Posted on May 6, 2022
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Summary

The Central Employee Services Division (CESD) within King County's Department of Human Resources (DHR) seeks a detail-oriented and knowledgeable professional to fill the role of Law Enforcement Officers and Firefighters (LEOFF-1) Medical Claims Specialist. Reporting to the Benefits and Payroll Manager, this position is responsible for managing medical, dental and vision claims to reconcile accounts for active and retired LEOFF-1 members.

 
The Central Employee Services Division supports a thriving King County employment experience and provides integrated compensation, benefits, work/life well-being, safety, and retirement planning services.
 
The LEOFF-1 Medical Claims Specialist will play a key role in the day-to-day delivery of effective customer service to members of LEOFF-1, while also maintaining the integrity of the claims process through compliance with Washington state laws and King County policies and procedures. Relationship-building and strong analytical skills ensure that the LEOFF-1 claims process is responsive to customers and conforms with the County's goals and practices.
   
The successful candidate will be able to effectively manage the LEOFF-1 program by balancing exemplary service to members with a fiscal responsibility to the organization. You will use your strong interpersonal skills to develop and leverage relationships and facilitate collaborative 
problem solving. You will bring experience in claims negotiation and resolution, along with knowledge of laws, regulations, and financial principles that guide and direct the LEOFF-1 program.
 
 Other Position Information 
This position is non-exempt from the provisions of the Fair Labor Standards Act and is overtime-eligible. Employees have a standard 40-hour workweek and are paid on a bi-weekly schedule every other Thursday. This position is represented by Teamsters Local 117/Professional & Technical.
 
King County
As the only county in the United States named after Martin Luther King Jr., one of the most influential civil rights leaders in our nation's history, King County is a vibrant community with residents that represent countries from around the world. It is a region with increasing diversity that cherishes the artistic and social traditions of many cultures. Together, we're changing the way government delivers service and winning national recognition as a model of excellence.
 
We continue to build on an enduring legacy of shared values of equity and social justice, employee engagement, innovative thinking, and continuous improvement.  With this commitment, King County has adopted a pro-equity agenda aimed at advancing regional change and is developing the systems and standards necessary to achieve better outcomes for all residents, regardless of their race or income.  All of these qualities make King County one of the nation's best places to live, work, and play.

Job Duties

Successful candidates for this position will be able to clearly demonstrate skill and ability to:
     

  • Manage all LEOFF-1 claims according to contractual and policy provisions to reach agreement with claimants
  • Determine classification of claims for immediate payment, referral to King County Disability Retirement Board, subrogation, or rejection
  • Identify potentially negotiable claims, using discretion and tact to get willful action or consent for discounting payment
  • Investigate claims that show an attempt to use fraudulent tactics, taking appropriate action to rectify or reject claims that contain false statements, misrepresentations, and/or deliberate omission of facts 
  • Prioritize claims based upon complexity, responding in a timely manner to avoid late payment complaints and possible referral to collection agencies and other third parties
  • Counsel LEOFF-1 members or persons fiscally responsible for their welfare, interpreting patterns of behavior to explain and suggest various options for reconciling medical claims payments
  • Coordinate and prepare the LEOFF-1 medical program element, including financial forecasts for developing departmental budget, conducting analyses of fiscal impacts to select appropriate cost-minimizing techniques based on statistical and medical claims information
  • Research changes in laws and policies affecting the claims management program for King County and its LEOFF-1 members, advising on actions necessary to ensure adherence to existing and new legislation and updating standard operating procedures in response to revisions
  • Prepare documentation and evidence to defend and support participation in cases involving LEOFF-1 medical claims that are threatened or referred to litigation
  • Ensure confidentiality of all medical information about LEOFF-1 members in accordance with the Health Insurance Portability and Accountability Act (HIPAA) without compromising effective care
  • Develop and maintain a benefits record-keeping and filing system to store and easily retrieve information regarding pattern development, trends, and statistics, while retaining a historical reference of benefit accounts

Experience, Qualifications, Knowledge, Skills

The ideal candidate for this role will:
  

  • Have knowledge of claims procedures, to include medical claim accounting structure, principles, and practices, along with knowledge of government insurance programs
  • Effectively communicate medical claims processing regulations to non-technical individuals
  • Have experience managing defined and flexible medical related benefit plans
  • Be able to provide appropriate recommendations for changes to LEOFF-1 practices and procedures based on knowledge of laws, policies, rules, and regulations 
  • Accurately interpret complex medical, dental, and vision claims to expedite resolution
  • Have an ability to apply knowledge of fiscal analysis methods, budget preparation, and projections in guiding the LEOFF-1 medical claims program
  • Possess excellent customer service and interpersonal skills, including the ability to work productively with different levels of management and staff under challenging conditions
  • Be skilled in independently making accurate medical claims management decisions based on medical billing criteria, cost-effectiveness, negotiation, premium computations, King County policies, and management techniques
  • Work effectively and efficiently under pressure, managing numerous projects and tasks simultaneously, while prioritizing assigned work to meet established deadlines
  • Maintain client confidentiality and limit liability by keeping medical, financial, and other sensitive information secure and confidential
  • Exhibit skill in dealing with people of diverse socio-economic backgrounds and groups or individuals in sensitive situations
  • Demonstrate technical skill in using current office software including word processing, spreadsheet, database and email programs

Additional qualifications that will be helpful in this role:
   

  • Experience in a public sector organization and working within a political environment
  • Specific knowledge of and experience in handling LEOFF-1 medical claims 
  • Ability to apply relevant accounting practices and techniques
  • Skill in preparation of cost reports and other statistical claims information

Supplemental Information

To Apply:
King County values diverse perspectives and life experiences.  We encourage people of all backgrounds to apply including people of color, immigrants, refugees, women, LGBTQ+, people with disabilities, veterans, and those with lived experience.

 
If you are ready to bring your passion and enthusiasm for public service with a deep understanding and appreciation for the vital role it plays within King County, please apply online at  
Careers at King County.  An online employment application, with employment history going back at least 10 years (or more to include all relevant experience), and a cover letter that describes your skills, abilities and qualifications related to this role are required.
 
Interested individuals who apply by May 20, 2022 will receive first consideration in the process.
 
Questions:
For more information regarding this recruitment, please contact:

stepking@kingcounty.gov
  

Teleworking Requirement:
The work associated with this position will be performed through a combination of teleworking and onsite work and meetings. Employees will have access to shared workspaces at various King County facilities. Employees must reside in Washington state and within a reasonable distance to their King County worksite to respond to workplace reporting requirements.
   
Employees will be provided with a County-issued laptop and must maintain a workspace with an internet connection (access may be supplemented in some situations) where they can reliably perform work and remain available and responsive during scheduled work hours. Please note that when an employee conducts work that is likely to bring them in contact with another individual, safety precautions are required, including the 
wearing of masks in some situations. King County is doing its part to reduce the spread of COVID-19 and remains committed to reducing our carbon footprint.
   
King County has a robust collection of 
tools and resources to support working remotely. The individual selected for this opportunity will be joining an innovative and progressive team that is redefining how we work as we transition to the department's hybrid environment.  
 
COVID-19 Vaccination Requirement:
King County Executive Branch employees are required to be fully vaccinated against COVID-19. If you are the successful candidate for the position you applied for, the County will send you a conditional offer letter.
 
As a condition of employment, prior to a final offer of employment, you will be required to:
 

  • submit proof of vaccination or
  • have an approved request for medical or religious exemption and an approved accommodation. Philosophical, political, scientific, or sociological objections to vaccination will not be considered for an exemption or accommodation.

People are considered fully vaccinated against COVID-19 two weeks after receiving the final dose of a vaccination approved by the Center for Disease Control and Prevention (CDC).
 
The Executive Branch includes employees in the Executive branch, the Assessor’s Office, Elections, the King County Sheriff’s Office, and the Executive Office.
 
Forbes recently named King County as one of Washington State's best employers.
  

Together, with leadership and our employees, we're changing the way government delivers service and winning national recognition as a model of excellence. Are you ready to make a difference? 
Come join the team dedicated to serving one of the nation's best places to live, work and play.
 
Guided by our "
True North", we are making King County a welcoming community where every person can thrive. We value diversity, inclusion and belonging in our workplace and workforce. To reach this goal we are committed to workforce equity. Equitable recruiting, support, and retention is how we will obtain the highest quality workforce in our region; a workforce that shares and will help advance our guiding principles--we are one team; we solve problems; we focus on the customer; we drive for results; we are racially just; we respect all people; we lead the way; and we are responsible stewards. We encourage people of all backgrounds and identities to apply, including Native American and people of color, immigrants, refugees, women, LGBTQ+, people living with disabilities, and veterans.

King County is an Equal Employment Opportunity (EEO) Employer
No person is unlawfully excluded from employment opportunities based on race, color, religion, national origin, sex (including gender identity, sexual orientation and pregnancy), age, genetic information, disability, veteran status, or other protected class. Our EEO policy applies to all employment actions, including but not limited to recruitment, hiring, selection for training, promotion, transfer, demotion, layoff, termination, rates of pay or other forms of compensation.

King County offers a highly-competitive compensation and benefits package designed to meet the diverse needs of our employees and support our employees' health and well-being.  Eligible positions receive the following benefits and have access to the following programs:

  • Medical, dental, and vision coverage: King County pays 100% of the premiums for eligible employees and family members
  • Life and disability insurance: employees are provided basic coverage and given the opportunity to purchase additional insurance for both the employee and eligible dependents
  • Retirement: King County employees are eligible to participate in a pension plan through the Washington State Department of Retirement Systems and a 457(b) deferred-compensation plan
  • Transportation program and ORCA transit pass
  • 10 paid holidays each year (plus 2 personal holidays)
  • Generous vacation and paid sick leave
  • Paid parental leave, family and medical leaves, and volunteer leave
  • Flexible Spending Account
  • Wellness programs
  • Onsite gyms and activity centers
  • Employee giving program
  • Employee assistance programs
  • Flexible schedules and telecommuting options, depending on position
  • Training and career development programs
For additional information about employee benefits please visit our Benefits, Payroll, and Retirement Page.

This is a general description of the benefits offered to eligible King County employees, and every effort has been made to ensure its accuracy.  If any information on this document conflicts with the provisions of a collective bargaining agreement (CBA), the CBA prevails.  Also, in the event of any incorrect information in this document, applicable laws, policies, rules, CBAs, or official plan documents will prevail.
 
NOTE:  Benefits for Term Limited Temporary (TLT) or Short Term Temporary (STT) positions, including leave eligibility and/or participation in the pension plan through the Washington State Department of Retirement Systems, will vary based upon the terms and details of the position. Short Term Temporary positions are not eligible for an ORCA transit pass.
 
For inquiries about the specifics of this position, please contact the recruiter identified on this job posting.

01
Please indicate below the software in which you have a demonstrated proficiency (check all that apply):
  • MS Word
  • MS Excel
  • MS Outlook
  • Adobe
  • SharePoint
  • None of the above
02
How many years of experience do you have providing customer service regarding medical claims?
  • No Experience
  • Less than 2 years
  • 2 to 4 years
  • More than 4 years
03
How many years of experience do you have in claims negotiation and resolution?
  • No experience
  • Less than 2 years
  • 2 to 4 years
  • More than 4 years
04
Are you applying to this position as an eligible current or previous King County Employee Priority Placement Program Participant? Is this position the same or lower percentage of full-time when compared to the position held at the point of the notification of layoff? Do you possess the skills and abilities to qualify for this position?
  • Yes, I was given a layoff notice from my role at King County and I am within two years of the effective date of my layoff. Additionally, the position I was laid off from was the same or a higher percentage of FT status when compared to this one.
  • No.
05
If you answered yes to the question above and you are applying for this position as a Priority Placement Participant, to be considered, you must provide the following three pieces of information in the space provided: 1. The title you held when you received your layoff notice 2. The department you worked in 3. The effective date of your layoff

Required Question