Data Control Section Manager (SPSA, Opt 1)
Springfield, IL, US, 62704
Job Requisition ID: 48057
Start date: 7/3/25
Closing Date: 07/18/2025
Agency: Department of Healthcare and Family Services
BPIS: 11422
Class Title: SENIOR PUBLIC SERVICE ADMINISTR - 40070
Skill Option: General Administration/Business Marketing/Labor/Personnel
Bilingual Option: None
Salary: Anticipated starting salary range $10,500-$12,500/based on experience
Job Type: Salaried
Category: Full Time
County: Sangamon
Number of Vacancies: 1
Bargaining Unit Code: None
Merit Comp Code: Excluded - Federally Funded
****************A RESUME IS REQUIRED FOR THIS JOB POSTING****************
Please attach a DETAILED Resume/Curriculum Vitae (CV) to the MY DOCUMENTS section of your application. You WILL NOT be considered for the position if you attach a CMS100, CMS100b or any other document that is not a Resume or CV.
Why Work for Illinois?
Working with the State of Illinois is a testament to the values of compassion, equity, and dedication that define our state. Whether you’re helping to improve schools, protect our natural resources, or support families in need, you’re part of something bigger—something that touches the lives of every person who calls Illinois home.
No matter what state career you’re looking for, we offer jobs that fit your life and your schedule—flexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.
Position overview:
The Department of Healthcare and Family Services, dedicated to improving lives for 3.2 million Illinoisans, is seeking to hire a highly motivated, qualified individual to serve as the Medical Claims Processing Manager. The ideal candidate will demonstrate an overall strong skill set that will ensure the Bureau of Claims Processing maintains the highest level of standards in all operations within the Bureau, particularly in processing medical claim documentation for timely payments to the provider community, payment adjustments and receipt and processing of customer documentation to administer and continue medical benefits, online correction and utilization review of provider submitted invoices for proper payment adjudication. The candidate will also demonstrate their dedication to teamwork, the ability to work in a fast-paced, ever-changing environment, a strong supervisory background including experience managing a large entry level staff, experience managing large scale processing operations, and the desire to promote and provide quality services on behalf of the State of Illinois.
HFS values employees with different backgrounds, life experiences, and talents.
Employees receive a robust benefit package including:
- Monday-Friday work schedule
- Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.)
- Health, Life, Vision, and Dental Insurance
- Pension Plan
- Paid Parental Leave
- Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
- Employees earn (12) paid Sick Days annually.
- New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
- Employees earn (3) paid Personal Days annually.
- (13-14) paid holidays annually (based on start date)
If you are seeking a new opportunity, and this position appeals to you, please apply today!
At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained.
HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.
Essential Functions
- Subject to management approval, serves as the Data Control Section Manager by planning, developing, evaluating, and managing the operations of the Data Control Section in relation to the adjudication and maintenance of medical invoices submitted in accordance with the Medicaid Program as well as the intake processing of customer Medicaid applications and supporting documentation/forms for case maintenance
- Serves as full line supervisor
- Directs the operation of the statewide processing for Optical Prescription Orders (OPOs), the special handling of invoices and/or documents with or without attachments, provider incomplete and reject reports, tasks associated with processing checks and/or adjustments, tax levies, Medical Schedule Releases, Medicaid customer application information and city wide pick up/deliveries for the Bureau as well as the Department
- Directs the research and analysis of claim data relating to statewide/Medicaid fraud investigations, State Police and other enforcement/prosecutorial investigations, auditor requests, Prompt Payment Interest (PPI) monitoring and County Jail claim reimbursement processing
- Consults with management on the integration of program activities
- Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above
Minimum Qualifications
- Requires knowledge, skill, and mental development equivalent to four (4) years college
- Requires prior experience equivalent to four (4) years of progressively responsible administrative experience working in the field of medical claims processing or medical insurance
Preferred Qualifications
- Minimum of three (3) years of experience in supervising a professional staff in an office setting
- Minimum of three (3) years of professional experience directing a public or private organization regarding the processing of checks and/or adjustments, invoices, provider reports, tax levies, and warrants through a comptroller’s office
- Minimum of three (3) years of experience working with on-line claim processing and/or database claim processing
- Minimum of two (2) years of professional experience developing and implementing program and operational policies and procedures
- Minimum of three (3) years of experience researching and analyzing large sets of claims data
- Minimum of two (2) years of professional experience communicating with stakeholders at all levels within an organization, both internal and external
- Minimum of two (2) years of experience working with personal computer software such as Microsoft Office applications
- Minimum of one (1) year of professional experience providing supporting documentation for deposition and/or testimony in a State or Federal court of law
Conditions of Employment
- Requires the ability to pass a background check and self-disclosure of criminal history
- Requires the ability to travel in the performance of duties, with overnight stays as appropriate. Requires a valid and current driver's license
- Requires the ability to utilize and maintain state issued equipment such as a laptop
- This position has been found to meet the requirements in section 4A-101 of the Illinois Governmental Ethics Act requiring the occupant/employee to file a Statement of Economic Interest. The Illinois Governmental Ethics Act (5 ILCS 420/4A et seq.) requires certain state officials and employees to file annual Statements of Economic Interest with the Office of the Secretary of State that will be made available for examination and copying by the public. All employees required to file a Statement of Economic Interest are also required to file the Supplemental Statement of Economic Interest with the Executive Ethics Commission. (See Executive Order 15-09) Fines and penalties apply to untimely filings.
- The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description
Work Hours: Monday - Friday 8:30 a.m. - 5:00 p.m.
Work Location: 201 South Grand Ave E Springfield, IL 62704-3803
Email: HFS.DMPApps@illinois.gov
Posting Group: Leadership & Management
The main form of communication will be through email. Please check your “junk mail”, “spam”, or “other” folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:
- donotreply@SIL-P1.ns2cloud.com
- systems@SIL-P1.ns2cloud.com
Nearest Major Market: Springfield