PRINCIPAL CLAIMS REVIEWER
New Jersey treats Principal Claims Reviewer as a competitive-class job, so the gate is an examination and the ranked list it produces rather than a direct offer.
The spec names a bachelor's degree, but it leaves the door open to substitute experience for the degree. The FY 2027 range lands between $69,668 and $101,951, and state payroll currently lists 6 people in the title, most of them at Human Services.
How to apply
This title is filled by competitive examination.
See every real route in, and where to apply. 2 agencies employ it. We don't track live vacancies.
See all 2 employers and how to apply →Who employs this title
Principal Claims Reviewer appears on the State payroll at 2 departments, most of them at Department of Human Services.
State departments
| Employer | Employees |
|---|---|
| Department of Human Services | 5 |
| Department of Health | 1 |
State payroll and independent authority payroll are separate systems and are never merged. See data sources.
Who employs this title
State payroll records show 6 people working under this title. The median actual salary is $96,944. The agencies employing the most are:
- Human Services (5)
- Health and Senior Services (1)
Counts from NJ YourMoney agency payroll. See statewide workforce analytics.
Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under the general supervision of a supervisory official, supervises a section engaged in the review and processing of eligibility claims related to financial and/or health care services in health or human services programs and/or supervises the investigation of the potential of third-party liability for recovery of funds; supervises staff and work activities; prepares and signs official performance evaluations for subordinate staff; does other related duties as required.
Examples of work
Supervises the activities of the claims review and error resolution section in the analysis and processing of claims. May provide suggestions for more effective methods of claims processing. Supervises claims processing activities for timeliness of payments. Reviews and processes complex claims to determine eligibility for financial and/or health care benefits and services; corresponds with private providers and governmental agencies to resolve claim problems. Calculates earned and unearned income for individuals to determine eligibility. Contacts various government agencies, providers, and recipients to gather information for complex eligibility determinations. Supervises the review of investigations, third-party liability claims, and determines the viability for recovery of financial and health care service funds; effects recoveries and recommends settlements. Supervises the review of the receipt and transmittal of recovered funds; oversees preparations for the filing and discharge of liens; initiates updates of various files. Responds to complex inquiries and assists applicants in obtaining, transferring, or returning benefits; interprets and explains State and federal rules and regulations regarding health or human services programs, or laws related to other State financial aid programs. (Examples of health or human services programs may include Medicaid, Lifeline Utility Assistance, etc.). Provides technical assistance and guidance to subordinate employees having questions or problems with claims. Supervises the work operations and/or functional programs and has responsibility for effectively recommending the hiring, firing, promoting, demoting, and/or disciplining of employees. Refers cases of suspected fraud and abuse; provides information on cases to be litigated. Compiles data and prepares reports of claims matters containing findings, conclusions, and recommendations. Compiles documentation for hearings; may interpret regulations to Administrative Law Judges. Supervises the establishment and maintenance of records and case files. Will be required to learn how to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
Knowledge, skills and abilities
Knowledge of applicable financial and/or health care services and programs offered in New Jersey. Knowledge of modern business office routines and their practical application. Knowledge of the techniques used to obtain information, review, and evaluate eligibility claims. Knowledge of the problems encountered in the investigation and processing of eligibility claims. Ability to supervise assigned staff and plan, organize, and implement projects within the unit. Ability to read and interpret laws, rules, and regulations, and apply them to specific situations. Ability to compile information needed for eligibility determinations. Ability to establish and maintain cooperative working relationships with clients, providers, and others. Ability to review and determine the validity of eligibility claims. Ability to provide advice and assistance to subordinates in handling technical claim problems. Ability to identify suspected cases of fraud and abuse of claims. Ability to prepare correspondence and reports containing findings, conclusions, and recommendations. Ability to supervise the establishment and maintenance of records and files. Ability to learn how to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, and communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible if they can perform the essential functions of the job with or without reasonable accommodation. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. Applicants must meet one of the following or a combination of both experience and education. Thirty (30) semester hour credits are equal to one (1) year of relevant experience. Seven (7) years of professional experience in the evaluation and/or verification and eligibility determination of applications for financial or medical assistance, benefits or other health or human services programs, or in credit investigations for recovery of funds. OR Possession of a bachelor's degree from an accredited college or university; and three (3) years of the above-mentioned professional experience. "Professional experience" refers to work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the authority to act according to one's own judgment and make accurate and informed decisions.