Tort & Casualty Specialist

Tort & Casualty Specialist

Salary

$59,460.00 - $77,304.00 Annually

Location

Statewide, CO

Job Type

Full Time

Job Number

UHA02009 07.2026

Department

Department of Health Care Policy and Financing

Division

Medicaid Operations Office

Opening Date

06/12/2026

Closing Date

6/23/2026 11:59 PM Mountain

FLSA

Determined by Position

Type of Announcement

This position is open only to Colorado state residents.

Primary Physical Work Address

303 E 17th Ave Denver, CO 80203

FLSA Status

Exempt; position is not eligible for overtime compensation.

Department Contact Information

Jay Julian, Talent Acquisition Specialist ~ jay.julian@state.co.us

How To Apply

Please submit an online application for this position at https://www.governmentjobs.com/careers/colorado. Reach out to the Department Contact to apply using a paper application, including any supplemental questions. 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.

• Description
• Benefits
• Questions

Department Information

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

NOTE: This announcement may be used to fill multiple openings.

Envision yourself working at HCPF

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.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorados Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible Spending Accounts (FSAs)

• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)

• 11 Paid Holidays Annually and Accrued Annual and Sick Leave

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• Variety of discounts on services and products available through the State of Colorados Work-Life Employment Discount Program

• Free RTD EcoPass to all eligible State Employees

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are looking for a Tort & Casualty Specialist to join our Third-Party Liability & Recoveries team!

The Third-Party Liability & Recoveries function ensures that Medicaid dollars are spent appropriately and in compliance with state and federal regulations. The Sections purpose is to pursue third party payment of medical costs for Medicaid eligible clients to expand purchasing power for public benefits.

Methods used include: (1) avoid costs where appropriate by identifying third party payers and directing claims to them for payment, (2) recover medical payments from liable third parties where it is not possible to deny or divert claims, (3) identify areas of waste such as eliminating funding of Medicaid to ineligible individuals.

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.

Description of Job

This position recovers Medicaid dollars spent on behalf of clients when another party is liable for the costs.

WHAT YOULL BE DOING AS TORT & CASUALTY SPECIALIST:

• In the context of tort & casualty cases, evaluates referrals from clients, attorneys, property & casualty carriers, medical malpractice carriers, and mass tort lien administrators to determine whether Medicaid may have a lien for any medical assistance that should be borne by the at fault party.
• Analyzing claims in the case management system and comparing the treatment rendered to the nature of the injury or incident to determine whether the Department may have a lien. Following this claim analysis, communicates with parties to provide the report of Medicaid's expenditures if treatment is identified that is related to the incident or accident.
• Identifies criminal cases with potential recoveries by responding to state district attorneys in cases where Medicaid may be entitled to restitution. In these cases, the Medicaid client may have been injured as a result of criminal conduct. The Department is entitled to restitution considering its status as a potential victim. Evaluates claims to determine whether Medicaid paid for treatment that should be borne by the defendant. Pursuing restitution entails working with district attorneys, victim coordinators, and representing the Department in court.
• Monitors cases to ensure that settlements are not disbursed prior to Medicaid recouping its lien. Periodic monitoring of cases ensures that lien totals are up-to-date, and the unit is apprised of any changes in the case and tracks the case as the personal injury attorney brings the case to a conclusion. The expected volume of cases is approximately 600 to 700 at any given time.
• Monitors cases to ensure counsel is making adequate efforts to recover the Medicaid lien. Determines whether referral of the case to the AGO is necessary to protect the Department's lien.
• Negotiates settlements in personal injury cases based on facts and the legal strengths of the case. Position also drafts letters to counsel informing them of the Department's calculation of the Medicaid lien. For example, at the appropriate point in the litigation timeline determined by the rules of civil procedure and the orders of court, the position will be contacted by the Medicaid recipient's counsel to inform the Department of any pending settlement offers or the timing of a settlement conference.
• Attends in person or by telephone at those conferences and mediations involving significant lien amounts and using the guidance established by the unit's procedures and the position's discretion whether to attend mediation.
• Other duties as assigned.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

RESIDENCY REQUIREMENT:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

CLASS CODE & CLASSIFICATION DESCRIPTION:H1B3XXADMINISTRATOR III

MINIMUM QUALIFICATIONS:

Experience Only:

Six (6) years of professional experience in medical claims analysis, working with personal injury claims; or negotiating settlements.

OR

Education and Experience:

A bachelors degree from an accredited institution in Health Policy, Health Administration, Business Administration or a field of study related to the work assignment; and two (2) years of professional experience in medical claims analysis, working with personal injury claims; or negotiating settlements.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associate will count as two years of experience.
• A bachelors will count as four years of experience.
• A masters degree will count for six years of experience.
• A doctorate or juris doctorate degree will count for seven years of experience.

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

PREFERRED QUALIFICATIONS:

• Prior state experience related to the duties of this position

• Experience in financial recoveries on behalf of individuals when another party is liable for the costs

• Experience working in a claims system or other similar information technology platform and creating and using spreadsheets to analyze data such as Microsoft Excel

• Experience negotiating as well as resolving disputes with adverse parties

• Experience with soliciting advice of counsel

• Experience applying the facts of a case to a law, rule, or guideline and clearly articulating one's rationale

DEFINITION OF PROFESSIONAL EXPERIENCE:

Work that involves exercising discretion, analytical skill, judgment, 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.

CONDITIONS OF EMPLOYMENT:

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.

• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

APPEAL RIGHTS:

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department's action.

For further information on the Board Rules, you can 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, atspb.colorado.gov/board-rules.

Supplemental Information

How to Apply (PLEASE READ CAREFULLY)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations:

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing 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, Minnie Kaur, at anupreet.kaur@state.co.us.

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for detailed information: www.colorado.gov/pacific/dhr/benefits

Please note that each agencys contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.

01

All HCPF positions are security-sensitive positions and require potential employees to undergo a criminal record background check. As a condition of employment, you will be required to submit to pre-employment screening if offered the position. Are you willing to meet this requirement?

• Yes
• No

02

Do you have any relatives or significant others working at the Department of Health Care Policy & Financing? If so, please list their names here. Otherwise, please list N/A.

03

Per the requirements of the Step Pay Program implemented on July 1, 2024, any State employee must be paid a rate that is equal to or greater than the appropriate step pay rate within their classification's pay range based on completed years in their current class series as of June 30. All current and former State employees must ensure that your entire work history within the State Classified System, including at Institutions of Higher Education, is indicated in your application so that your time-in-series can be calculated accurately. Please verify that this information is included in your application in the supplemental questions.

• Yes
• No

04

Are you willing to accept an offer within the posted salary range?

• Yes
• No

05

Former state employees who were disciplinarily terminated or resigned in lieu of termination must disclose the information on the application. In the space below, please provide an explanation as to why the prior termination or resignation should NOT disqualify your application from the current position. Otherwise, please list N/A.

06

One of the responsibilities of this position is to negotiate effectively with attorneys of accident victims over the amount of the Medicaid lien. For example, the personal injury attorney may dispute the relatedness of the medical charges to the accident or may feel that reimbursing the Department for its lien will result in too little money for their client. Choose a specific experience in which you had a conflict with another party in which you were responsible for the outcome of the negotiation and the other party was opposed to your position. Describe the specific principles you used to negotiate with this party and describe the outcome.

07

This position requires the use of a case management system with an automated workflow to facilitate timely completion of tasks. Briefly describe how you organize work-related tasks, and any mechanisms employed to follow up on those tasks. Please include any specific experience working in a case or claim management application.

08

List any additional relevant experience you would like us to consider in determining if you meet the qualifications of this position. Please, include the months and years relevant to the experience you describe.

Required Question

Employer State of Colorado

Address See the full announcement by clicking

the "Printer" icon located above the job title

Location varies by announcement, Colorado, --

Website https://careers.colorado.gov/