|
Commonwealth of Pennsylvania |
|
|
POSITION DESCRIPTION FOR JOB POSTING |
|
|
Position Number: 00210741 |
Description Activated On: 7/22/2026 9:08:03 AM |
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. The incumbent in this position is responsible for reviewing, analyzing, and computing all medical, cash, personal injury, and estate claims in which the department is seeking a recovery. This position is in the Statement of Claim (SOC) Creation Unit, Recovery Section, Division of Third-Party Liability (TPL), Bureau of Program Integrity, Office of Administration. |
|
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. Responsible for independently reviewing and performing complex work that involves the decoding, interpretation and summarizing of cash and/or medical assistance by using the appropriate medical procedures, drugs, long term care, and follow-up care relating to either specific personal injury or decedent estates in which the Department of Human Services is seeking recovery. Review and calculate medical and cash payments, which are essential to identify adjustments to claims to create and/or update the statement of claim. Review recipient history and eligibility files in CIS and PROMISe systems to determine date range for medical and cash assistance claims. Responsible for researching PACSES and OARS; calculating, updating and posting appropriate cash assistance or overpayment claims and credits using the correct liability standard while allowing for applicable credits and debits via child care, child support and/or spousal support and special allowances permitted by federal law. Responsible for contacting nursing home facilities, county assistance offices, hospice and mental health facilities for long term care and other information pertinent to completing casualty and estate statement of claims. Communicating with Agents/Investigators and supervisors. Review and interprets complex client encounter data in different formats from Managed Care Organizations (MCO). This requires detailed knowledge of each plan’s format to explain the fiscal processes used to arrive at the statement of claim amount due and owing to the Commonwealth. Complete understanding of Medical Assistance and federal regulations needed to do the preparation and completion of the statements of claims. Analyze and apply governmental regulations and policies for Estate and Casualty cases, which involves making complex and independent decisions in determining the proper procedures to be followed. Analyze correspondence, medical forms, and attorney letters to determine types of injuries to be used in the completion of the statement of claim. Provides statistics to supervisor for case tracking and management reports. Performs 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. Responsible for making independent decisions in the computation of the Statement of Claims. Responsible for interpreting Federal and State laws, regulations, and policies as it relates to computation of statement of claims. |
||||||||||||||||||||
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. |
||||||||||||||||||||
Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
|