Complex Interactions Specialist (Administrator III) DORA Division of Insurance
Job Location:
Denver, CO - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
- Department Information
Hybrid Workplace Arrangement:
Although this position will be designated under the departments hybrid workplace program it will still be required to report to the department office on a scheduled basis and at the discretion of the supervisor based on business needs.
This announcement may be used to fill multiple vacancies.
The Department of Regulatory Agencies (DORA) is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.
Consumer protection is our mission.
DORA values and promotes diversity supporting a workplace that is inclusive of people from different backgrounds and experiences; creating an environment that is reflective of our communities; promoting positive relationships; and putting forth unique perspectives to fulfill our mission.
Employer-sponsored RTD EcoPass with offices located at Civic Center Plaza above the RTD Civic Center station and just a few blocks from RTD light rail.
Extensive work-life programs such as flexible schedules training and professional development opportunities on a wide variety of subjects and more!
Employee wellness programs including the Colorado State Employee Assistance Program (CSEAP) which provides free confidential counseling services.
Bike-to-work programs including access to storage lockers and bike racks.
Flexible retirement benefits including a choice of the PERA Defined Benefit Plan or the PERA Defined Contribution Plan plus optional 401K and 457 plans.
Medical and Dental Health Insurance for employees and optional coverage for their dependents.
Life Insurance for employees and optional coverage for their dependents.
Paid Time Off including 11 paid holidays.
Short- and long-term disability coverage.
Tuition assistance program.
Check out our excellentbenefitspackage!- Description of Job
The Colorado Division of Insurance (DOI) regulates the insurance industry in Colorado. The DOI helps consumers by answering their questions investigating their complaints and helping them to understand their insurance. The DOI regulates and monitors the insurance companies in Colorado and insurance agents to ensure everyone follows the law.
The Senior Medicare Patrol (SMP) is a national program funded by the U.S. Department of Health and Human Services Administration for Community Living (HHS/ACL) through a federal grant on an annual funding cycle beginning of June of each year. Under this grant this work unit the Colorado SMP program is tasked with providing Medicare fraud education and responding to fraud and abuse allegations reported directly by consumers or referred by agencies throughout the state. The outreach and education portion of the program is conducted primarily by fifteen (15) sub-grantee agencies consisting of Area Agencies on Aging volunteer programs community agencies and non-profit organizations around the state which the Senior Health Unit at the Division of Insurance in DORA oversees. The complaint investigation function is centralized in the state additionally referrals for further investigation and enforcement are made to appropriate federal and/or state partners. As such protection of vulnerable consumers is a core component of the SMP as is eliciting the involvement of volunteers and other SMP team members at the local sub-grantee agencies to help educate beneficiaries and their caregivers on how to prevent detect and report Medicare fraud abuse and errors.
Position: SFA 64165
This position exists to investigate and assess consumer and other reports of suspected fraud abuse or error by Medicare healthcare providers or marketing agents and refer cases for federal or state enforcement actions as appropriate. This position focuses on SMP in the Senior Health (SHIP/SMP/MIPPA Programs) work unit. The position mentors and supports work done by the sub-grantee agency consisting of Area Agencies on Aging volunteer programs and community action agencies personnel and volunteers in the identifications and reporting of suspected Medicare fraud; handles basic information gathering for cases and refers more complex cases and questions. This position shares responsibility with the SMP Program Manager for managing database entries in the online reporting system to record suspected Medicare fraud and abuse.
Duties include but are not limited to:
- Creating and managing protocols and systems to ensure timely and comprehensive management of investigations and cases based on consumer complaints in order to prevent and/or report inappropriate expenditure of federal funds for benefits and maximize compliance by healthcare providers;
- Conducting conference calls with partners to hold refresher trainings on entering suspected fraud cases; joining conference calls and meetings with state and federal agencies and other investigative partners regarding case handling protocols and matters of interagency communication;
- Designing training content and setting standards for local affiliate personnel and volunteers to convey key preventive and remedial strategies to consumers; working with affiliate organizations around the state to provide high quality and timely consumer protection services including information and referral; educating federal and state agency partners regarding current trends and practices in prevention detection and prosecution of health care fraud in the Medicare program;
- Serving as a point of contact for receiving cases from subgrantees and ensuring submitted cases are complete from initial entry to closing;
- Cultivating and maintaining collaborative relationships with federal state and local agency partners involved in addressing health care fraud including SMP Programs in other states; educating federal state and local agency partners regarding current trends and practices in prevention detection and prosecution of health care fraud in the Medicare program; providing expertise on laws regulations and activities related to Medicare fraud; initiating and maintaining communication for interagency coordination of fraud investigations and prosecutions; and coordinating referral of appropriate cases to federal and state enforcement agencies.
- Minimum Qualifications Substitutions Conditions of Employment & Appeal Rights
MINIMUM QUALIFICATIONS (MQs):There are two ways to qualify for this position: 1) Experience OR 2) A Combination of Education and Experience
Option 1: Experience
- Six (6) years of professional* experience working for a healthcare provider a non-profit health advocacy organization in the health insurance industry in a health policy consulting environment or for a governmental regulatory entity which must include three (3) out of the four (4) of the following:
- Handling health insurance Medicaid and/or Medicare-related inquiries;
- Experience with fraud prevention and anti-fraud awareness;
- Coordinating and engaging in educational training about healthcare and/or healthcare fraud prevention; and/or
- Recordkeeping information gathering and/or document organization.
Option 2: A Combination of Education AND Experience
- Associates Degree and Experience:Graduation from an accredited college or university with an associates degree in business communications healthcare administration healthcare management public health health economics public administration public policy project management criminal justice or in a field of study related to the work assignment; AND
- Four (4) years of professional* experience working for a healthcare provider a non-profit health advocacy organization in the health insurance industry in a health policy consulting environment or for a governmental regulatory entity which must include three (3) out of the four (4) of the following:
- Handling health insurance Medicaid and/or Medicare-related inquiries;
- Experience with fraud prevention and anti-fraud awareness;
- Coordinating and engaging in educational training about healthcare and/or healthcare fraud prevention; and/or
- Recordkeeping information gathering and/or document organization.
OR
- Bachelors Degree and Experience: Graduation from an accredited college or university with a bachelors degree in business communications healthcare administration healthcare management public health health economics public administration public policy project management criminal justice or in a field of study related to the work assignment; AND
- Two (2) years of professional* experience working for a healthcare provider a non-profit health advocacy organization in the health insurance industry in a health policy consulting environment or for a governmental regulatory entity which must include three (3) out of the four (4) of the following:
- Handling health insurance Medicaid and/or Medicare-related inquiries;
- Experience with fraud prevention and anti-fraud awareness;
- Coordinating and engaging in educational training about healthcare and/or healthcare fraud prevention; and/or
- Recordkeeping information gathering and/or document organization.
Document this experience in your application IN DETAIL as your experience will not be inferred or assumed. Part time experience will be prorated.
SUBSTITUTIONS:
- Partial credit toward the degree requirement will be given for completed college/university coursework that did not result in a degree.A masters or doctorate degree from an accredited college or university in a field of study related to the work assignment will substitute for the bachelors degree requirement.
*Professional work involves exercising discretion analytical skill judgment and personal accountability and responsibility for creating developing integrating applying and sharing an organized body of knowledge that characteristically is: uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelors or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore extend and use additional discoveries interpretations and application and to improve data materials equipment applications and methods.
Preferred Qualifications:
- Demonstrated professional* experience working in a state government body reviewing public health and/or insurance complaints;
- Demonstrated professional* experience working in a fast-paced high-volume environment and adapting to shifting priorities as needed;
- Demonstrated professional* experience working with various vulnerable communities/populations;
- Demonstrated professional* experience investigating insurance fraud and/or conducting training about health care or health fraud prevention to consumers;
- Demonstrated professional* experience with healthcare fraud prevention and/or reporting suspected fraud;
- Demonstrated professional* experience with managing case-work collaborating with others to analyze a case and/or facilitating case resolution.
Required Competencies: The following knowledge skills abilities and personal characteristics are required competencies and may be considered during the selection process (including examination and/or interview):- Demonstrated written communication skills including the ability to convey information to various stakeholders in a clear accurate and concise written manner;
- Demonstrated verbal communication skills including the ability to effectively convey information to audiences in a concise manner;
- Demonstrated attention to detail in order to ensure accuracy thoroughness and consistency of work product generated in the work unit;
- Sound judgment and confidence in decision-making on a daily basis;
- Demonstrated critical thinking and analysis skills including having the ability to evaluate and analyze reports and records in order to ensure compliance and recommend solutions;
- Interpersonal skills including the ability to collaborate and maintain relationships with internal and external stakeholders;
- Customer service skills including the ability to diplomatically interact with difficult customers navigate difficult conversations and maintain communication with stakeholders;
- Organizational skills including prioritization planning and time management in order to meet deadlines;
- Creativity and flexibility including the ability to multi-task and adapt to shifting priorities in a fast-paced work environment;
- Knowledge of the federal and state statutes and regulations State Health Insurance Assistance Program (SHIP) Senior Medicare Patrol (SMP) and Medicare Improvement for Patients and Providers Act (MIPPA) including the Social Security Act Patient Protection and Affordable Care Act Medicare Modernization Act and fraud prevention;
- Demonstrated ability to train employees including explaining processes and procedures and the ability to create resources for training and educational purposes;
- Demonstrated ability to understand and abide by workplace principles practices and behaviors as internally identified and defined by the division and department;
- Demonstrated ability to read understand interpret apply and explain statutes rules policies procedures and guidelines;
- Ability to travel independently including work in-office as required by business need and scheduled by the supervisor;
- Integrity and high ethical standards;
- Accountability reliability including attendance;
- Ability to maintain confidential controversial or sensitive information;
- Self-starter including the ability to work independently learn new processes utilize own knowledge and that of supervisor and complete work with minimal supervision;
- Demonstrated professional demeanor;
- Knowledge and understanding in the use of PC software applications including Microsoft Office (Access Word Excel etc.) and Google Suite (Docs Sheets Slides Calendar etc).
Conditions of Employment: Candidates who fail to meet the conditions of employment will be removed from consideration.
- The successful passing of a reference check and/or if required a background check.
- A reference check may include but is not limited to: contacting previous and current supervisors to verify employment and discuss performance a review of the personnel file a review of the performance recorda review of job-related public information etc.
- The type of background check depends on the job duties of the position and can include a review of any criminal record credit report and/or driving record.
- Ability to travel independently including work in-office as required by business need and scheduled by the supervisor.
- Must possess and maintain a valid State of Colorado drivers license. This position requires the ability to travel up to 20% of the time including staying over weekends when required; and the ability to transport equipment including but not limited to laptop computers manuals and supplies.
- Six (6) years of professional* experience working for a healthcare provider a non-profit health advocacy organization in the health insurance industry in a health policy consulting environment or for a governmental regulatory entity which must include three (3) out of the four (4) of the following:
- Supplemental Information
PLEASE READ - Required Application Materials
Interested individuals must submit the following online:
1.A completed State of Colorado Application (log-in to your current NeoGov account or create a NeoGov account to complete the online application). Note: Incomplete applications including incomplete work history sections or see résumé see attachment or see addendum statements will not be accepted in lieu of a completed application form.
2. A current email address on your application as all communication pertaining to this position will be conducted via email. Please set up your email to accept messages from and @ addresses and check your email often. Note: The department cannot guarantee the successful delivery of email including incorrect filtering into junk mail folders.
3.A detailed cover letter explaining how you meet the required competencies and how your accomplishments qualifications skills areas of expertise personal characteristics etc. make you a good fit for this position; you may also attach additional documents that demonstrate this.
Comparative Analysis Process: Structured Application Review
Part of if not the entire comparative analysis process for this position will involve a review of the information you submit in your application materials; Therefore it is paramount that in the experience portion of your application and cover letter you describe the extent to which you possess the education experience and competencies outlined in the job announcement as well as the required and/or preferred qualifications/competencies. You are also encouraged to attach additional documents to that effect. Failure to include adequate information or follow instructions may affect your score and prevent you from competing in subsequent measures used to arrive at a top group of applicants.
Part of the comparative analysis process and/or the interview process may be conducted through remote video conferencing (i.e. Google Meet Zoom etc.)
Veterans Preference: Candidates who wish to assert Veterans Preference should attach a copy of their DD214 to their application. Failure to do so will result in being denied Veterans Preference.
PLEASE NOTE: Former State Personnel System employees who were disciplinarily terminated or resigned in lieu of termination must disclose this information on the application. Colorado Revised Statutes require that all state employees be hired and promoted through competitive examination of merit and fitness. Failure to include the required information failure to follow instructions and/or failure to submit materials by the application deadline may result in your application not being considered for the position and may affect your score or inclusion in the final pool of qualified candidates.
The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness.
The State is resolute in non-discriminatory practices in everything we do including hiring employment and advancement opportunities.
ADAAA Accommodations: DORA is committed to the full inclusion of all qualified individuals. As part of this commitment our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment including completing the application process interviewing completing any pre-employment testing participating in the employee selection process and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position please direct your inquiries to our ADAAA Coordinator at .
Check out our excellent benefits package!
THIS ANNOUNCEMENT MAY BE USED TO FILL MULTIPLE VACANCIES
While a salary range is posted for this position an eventual salary offer is determined by a comprehensive salary analysis which considers multiple factors including but not limited to education and experience compared to others in the organization doing substantially similar work.
Appeal Rights:
If you receive notice that you have been eliminated from consideration for this position you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.
An appeal or review must be submitted on the official appeal form signed by you or your representative. This form must be delivered to the State Personnel Board by email US Mail faxed or hand-delivered within ten (10) calendar days from your receipt of notice or acknowledgment of the departments action.
For more information about the appeals process the official appeal form and how to deliver it to the State Personnel Board go to or refer to 4 Colorado Code of Regulations (CCR) 801-1 State Personnel Board Rules and Personnel Directors Administrative Procedures Chapter 8 Resolution of Appeals and Disputes at under Rules.
HOW TO APPLY:Thank you for your interest. Submit an on-line application by clicking the link below or submit a State of Colorado Application for Announced Vacancy and all supplemental questions according to the instructions provided below. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed above.
IF NOT APPLYING ON-LINE SUBMIT APPLICATION TO:
Only online applications will be accepted for this position.
DEPARTMENT CONTACT INFORMATION:
Thanh Pham:
METHODS OF APPOINTMENT: Appointment to the vacancy or vacancies represented by this announcement is expected to be from the eligible list created. However at the discretion of the appointing authority the position(s) may be filled by another method of appointment for a valid articulated business reason.
Required Experience:
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