Job Description

If you are a current State of Maine employee, please submit your application through the internal application process using the Find Jobs report in PRISM. Seasonal employees who do not have PRISM access should apply through the State’s career page and indicate on the application that they have previously worked for the State.

.

Department of Health and Human Services (DHHS)

Reimbursement Specialist

Opening Date: March 20, 2026

Closing Date: April 2, 2026

Job Class Code: 0441

Grade: 20 (Professional & Technical Services)

Salary: $43,014.40 - $60,070.40 per year

Position Number: 02000-3301

Location: Augusta

This position allows for partial telework with management approval.

Currently, this position is not eligible for visa sponsorship or STEM OPT extensions.

Core Responsibilities:

As a reimbursement Specialist for PHIP (Private Health Insurance Premium) you will manage a portfolio of cases, determine whether or not the applicant is eligible for the program insurance cost reimbursement. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. You will generate reports and process all necessary paperwork to document case files. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below.

• Work with MaineCare Members to answer questions and assist in completing the PHIP Application.
• Review enrolment applications to ensure accuracy, and all required information is provided.
• Determine Eligibility, date eligible adding all information into the system module process manager.
• Track all open PHIP cases quarterly and ensure requirements continue to be met. Verifying mailing address at that time to avoid any delay of timely payments.
• Complete yearly re-enrollment’s maintaining and assigned Alpha Split.
• Provider management with reports and data necessary to the program evaluation.
• Assist with cross-training additional staff
• Work with a team to ensure a balance in work assignment.
• Abide by all MaineCare policies, procedures, and regulations regarding Private Healthcare Information. (PHI).
• The ability to work independently or with a team.

This position report’s to the Assistant Division Director of Medicaid and Medicare Services. This is a full-time position located at 109 Capitol Street, Augusta, Maine.

Minimum Qualifications:

A bachelor’s degree in accounting, Business Administration, or related field and one (1) year experience in health care insurance or related insurance field. Directly related work experience may be substituted for education requirements on a year-for-year basis.

Preferred experience includes:

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage

The backgrounds of the well-qualified candidate will demonstrate the following competencies:

• Knowledge of MaineCare or other health care insurance benefits, medical procedure codes, medical terminology and experience
• Demonstrated skills in using Microsoft Word, Excel, and database systems (such as ACCESS), including for report generation and analysis.
• Experience interpreting rules, regulations, and policies.
• Experience using claims-based applications, including research claims history.
• Excellent oral and written communication skills and customer service skills, including the ability to explain complex information to external audiences.

Thinking about applying?

Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your experience and passion set you apart.

Agency information:

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.

The Estate Recovery Unit is a part of the Third-Party Liability (TPL) team, within the Division of Operations in OMS. The federal government requires that states recoup Medicaid (MaineCare) costs paid on behalf of a member from age 55 until death from that member’s estate. Monies, recouped by Estate Recovery and other TPL business units, ensure that MaineCare is the payor of last resort.

Application Information:

For questions about this position, please contact Susan Allen at susan.allen@maine.gov

Please submit all documents or files in PDF or Word format.

To apply, upload a resume and cover letter addressing the competencies identified in the Minimum Qualifications section .

To request a paper application, please contact Lucia.Nadeau@Maine.gov

Benefits of working for the State of Maine:

No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements .
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave . Additional, unpaid leave may also be available, under the Family and Medical Leave Act .

State employees are eligible for an extensive and highly competitive benefits package , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness .

Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.

There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role.

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.

If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.

.

If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting.

Job Tags

Similar Jobs