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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00071355 |
Description Activated On: 9/4/2025 3:54:11 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Recovery of medical assistance expenditures that were incorrectly or provisionally paid on behalf of Department of Human Services (DHS) recipients. This is a statewide program, which is headquartered in the Recovery Section, Division of Third Party Liability, Bureau of Program Integrity, Office of Administration. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Assess collection of potential cash and medical assistance claims against third parties and recipients. This is accomplished by reviewing and analyzing referrals received from county assistance offices, medical providers, attorneys, insurance carriers, probate estates, other Commonwealth agencies and automated information systems, in order to determine if DHS benefits were inappropriately granted and to identify the responsible obligor. Investigate cash and medical assistance claims for personal injury and estate cases by employing independent judgment through verbal and written communications with attorneys, insurance adjustors, medical providers, police departments, recipients, other Commonwealth agencies and public inquires, in order to perfect the Department's claim. Develop and maintain a working knowledge of legal and regulatory aspects of cash and medical benefits by researching, analyzing and interpreting the Public Welfare Code, applicable Federal and State regulations and statutes, insurance laws and regulations and relevant probate codes. Claim overpayments include, but are not limited to cash, personal injury claims, worker's compensation, medical malpractice, probate estates and court ordered restitution. Work in conjunction with other units with Third Party Liability and the Office of the Inspector General, other Departmental agencies and County Probation Offices, to facilitate the efficient collection of claims. Maintain a working knowledge of the claims computation process and relevant documents in order to analyze, interpret and defend the legitimacy of the claim with interested parties. Maintains a working knowledge of the Automated Statement of Claim system. Negotiate settlements by making logical decisions based on the set of factors relevant to each case. The incumbent frequently assumes an adversary role; therefore, he/she must employ sound judgment and skilled diplomacy in order to maximize collections and maintain the best interest of the Department. Execute sound verbal and written communication skills in order to effectively outline the Department's claims and if necessary, defend the Department's position based on applicable Federal and State laws and regulations. This may include testifying in hearings and court appearances. Review payments received and resolve any discrepancies. Process payment notices accurately in order to ensure that collections are credited appropriately to maintain the integrity of the statistical reports. Maintain the integrity of the individual active case records by thoroughly reviewing cases distributed on a daily basis, recording significant events, and initiating appropriate follow-up measures. Accuracy must be maintained in order to facilitate future review and comprehension. Develop and maintain a working knowledge of the pertinent electronic data systems. This involves a basic knowledge of the use of the personal computers and an ability to access and interpret data available in the client and provider systems, medical systems, casualty WorkBench and Financial Accounting systems. Participate in special training sessions and research projects, which serve to enhance the overall quality of our operation. Written and oral presentations may be required. Perform other related duties as required. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Independently negotiate settlements with responsible third parties to recover from recipient’s tort settlements. Independently make decisions to effectively expedite an estate recovery. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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