Claims Specialist

Important Recruitment Information for this vacancy:

• Job Posting closes: January 12, 2026

Agency Information:

Kansas State Service Agency | Kansas Department of Administration

Verification of identity and employment eligibility to work in the United States is required by federal law. For a list of acceptable documents that establish these criteria, please refer to the federal Form I-9. While the Department of Administration (D of A) welcomes all candidates legally eligible to work in the United States, D of A does not provide sponsorships for this position.

E-Verify: Kansas Department of Administration (D of A) participates in E-Verify and will provide the federal government with your I-9 information to confirm that you are authorized to work in the U.S. For additional information regarding E-Verify, please click here. For additional information regarding Immigrant and Employee Rights (IER) please click here.

About the Position

• Who can apply: Anyone
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday - Friday, 8am - 5pm
• Eligible to Receive Benefits: Yes
• Veterans' Preference Eligible: Yes
• Application Deadline: January 12, 2026

Compensation:

• Hourly Pay Range: $ $26.28
• Note: Salary can vary depending upon education, experience, or qualifications.

Employment Benefits:

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement and deferred compensation programs

Visit the Employee Benefits page for more information

Position Description:

The Claims Specialist position is in the State Self Insurance Fund (SSIF) of the State Employee Health Benefits Plan (SEHBP) and reports to the Claims Supervisor.

Job Responsibilities:

• Complex Adjudication: Determine claim compensability by evaluating case facts with the Kansas Workers Compensation Act, administrative rules, and established case law.
• Financial Stewardship: Calculate and execute precise indemnity payments including child support withholdings. Research and negotiate settlements for functional disabilities within SSIF authority limits.
• Medical & Expense Oversight: Audit medical invoices for necessity and reasonableness; verify and process reimbursements for mileage, per-diem, and out-of-pocket expenses.
• Strategic Communication: Act as the primary point of contact for injured workers, medical providers, agency personnel and legal counsel. Provide expert guidance to claimants regarding their rights and benefits under the Act.
• Compliance & Documentation: Ensure all statutory notifications - including denials of compensability - are issued accurately and within mandatory timeframes to mitigate fund liability.

Return-to-Work & Collaborative Case Management

• Proactive Case Resolution: Lead multi-disciplinary collaborations with medical providers, legal counsel, and agency stakeholders to facilitate early Return-to-Work (RTW) outcomes, minimizing indemnity exposure and supporting worker recovery.
• RTW Advocacy: Strategically initiate and lead RTW discussions; coordinate technical job site or vocational rehabilitation evaluations to bridge the gap between medical restrictions and operational needs.
• Integrated Benefit Guidance: Serve as a subject matter expert on the intersection of Workers' Compensation, FMLA, and state leave policies (sick/vacation), ensuring both the agency and the employee navigate concurrent benefits accurately.
• Continuous Professional Excellence: Maintain mastery of evolving Kansas statutes by attending the annual DOL Workers Compensation Seminar and completing advanced technical training as directed.

Dispute Resolution & Litigation Management

• Alternative Dispute Resolution: Mediate complex conflicts between parties to achieve early resolution and minimize costly litigation.
• Legal Strategy & Advocacy: For cases requiring formal defense, prepare comprehensive legal summaries and defense theories. Employee will collaborate with defense counsel to prepare defenses strategy on compensability in preliminary, regular, and review/modification settings.
• Claims Authority: Retain full management and decision-making authority over claims, including collaboration with legal counsel on defense measures and structuring settlement frameworks for executive authorization.
• Discovery Compliance: Manage the timely and accurate delivery of records and evidence to claimant's counsel in accordance with legal discovery mandates.

Investigation & Analysis

• High-Threshold Investigations: Conduct end-to-end investigations for claims with exposure up to $60,000. This includes performing forensic interviews of claimants, supervisors, and witnesses to establish a definitive "Findings of Fact."
• Fraud & Abuse Detection: Identify and refer potential cases of fraud or abuse to the Assistant Attorney General. You will serve as a key witness and resource for the prosecution of fraudulent activity by claimants, providers, or legal counsel.
• Evidence Review: Analyze a diverse range of evidence—including personnel files, medical records, and wage statements—to produce clear, concise conclusions on compensability.

Financial Recovery & System Integrity

• Subrogation & Recovery: Identify and pursue opportunities for financial recovery from negligent third parties, product liability claims, and the Kansas Workers Compensation Second Injury Fund.
• Data Stewardship: Maintain high-integrity electronic files within the claims management system, ensuring all scanned documents and data points are triaged and acted upon within strict best-practice timelines.
• Workload Optimization: To maintain the industry benchmark of 80–150 cases per adjuster, this position is essential for distributing the annual volume of 2,000–3,000 new claims. This prevents "caseload creep," which is a primary driver of reporting errors and statutory penalties.
• Medical Cost Containment: This role ensures that medical authorizations are both "reasonable and necessary" and issued promptly. By directing quality care and ensuring timely payments, this position minimizes litigation risk and improves return-to-work timelines.
• Mission-Critical Support: This position provides the "significant effort" required to oversee medical care delivery, ensuring the State Self-Insurance Fund remains a leader in workers' compensation program success.

Minimum Qualifications

• High school diploma/GED.
• Two years of experience interacting with clients, customers, or the public in a social service, customer service, or problem resolution setting. Education may be substituted for experience as determined relevant by the agency.
• A valid driver's license is required.
• The incumbent will receive training in the provision of the HIPAA Privacy Regulations and HIPAA Security Regulations as they relate to the duties of this position and is required to sign a confidentiality agreement.

Preferred Qualifications

• Previous experience handling insurance claims.
• Case management experience.
• Data collection and management skills.
• Recording keeping abilities.
• Previous experience with Worker's Compensation.
• Knowledge of State of Kansas statutes, laws, regulations, and policies.
• Time management skills.
• Previous experience and understanding of HIPAA.
• Medical knowledge.
• Customer service experience.
• Communications skills, both verbal and written.

Post Offer Requirement:

Kansas Tax Clearance Certificate: A valid Kansas Tax Clearance Certificate is a condition of employment for all employees of the State of Kansas. Applicants (including non-residents) who receive a formal job offer for a State job, are required to obtain a valid Tax Clearance within ten (10) days of the job offer. A Tax Clearance can be obtained through the Kansas Department of Revenue who reviews individual accounts for compliance with Kansas Tax Law. Please be encouraged if you have a missing tax return(s) or you owe taxes to the State of Kansas, the Kansas Department of Revenue will work with you. The Kansas Department of Revenue can set you up on a