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Program Specialist - Recovery and Cost Avoidance

Nebraska Government

Lincoln, NE, USonsite

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About this role

The work we do matters! Hiring Agency: Health & Human Services - Agency 25 Location: Lincoln, NE Hiring Rate: $24.862 Job Posting: JR2026-00028537 Program Specialist - Recovery and Cost Avoidance (Open) Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed): 08-20-2026 Job Description: Are you interested in helping Medicaid maximize funds and reduce Medicaid costs while working to ensure members get needed healthcare and support?

State and federal law requires Medicaid to be the Payer of Last Resort. The Recover and Cost Avoidance (RCA) unit works with clients, providers, attorneys, insurers, and others to reduce the cost of Medicaid to citizens of the State of Nebraska. We accomplish this through four separate programs designed to support this aim:

Coordination of Benefits (COB): This team adds, verifies and maintains health insurance information of all Medicaid-eligible clients; allowing claims to process and pay timely. They also work with private Long-Term Care (LTC) insurers of Medicaid eligible clients to cover the client’ LTC services. This team cost avoided $2.7 million in total funds SFY2026.

Estate Recovery (ER): This team is responsible for pursuing and recovering eligible Medicaid payments when assets exist after a client passes away. This team recovered $8.9 million in total funds in SFY2026.

Health Insurance Premium Payment Program (HIPP): The HIPP program pays for health insurance premiums of Medicaid-eligible individuals if it is cost-effective for the State. If it costs Medicaid less to cover the equivalent set of services through the private health plan, then it is considered cost-effective. This team cost-avoided $4.7 Million in SFY2026.

Third Party Liability /Casualty (TPL): This team is responsible for ensuring Medicaid is the payer of last resort on all fee-for-service casualty and health claims when liability exists by other parties or insurance companies. This team recovered and cost avoided approximately $3.7 Million in SFY2026

Be a member of a team committed to improving efficiencies and tackling goals that support the Nebraska Medicaid mission to Help people live better lives.

“You have the passion; we have the opportunities - let's make a difference for Nebraskans!”   Examples of Work:

A Program Specialist on the RCA team will have opportunity to: • Review of health insurance benefit plans, explanation of benefits and medical and pharmacy claims history, financial and payment documentation, as well as verifying, approving and issuing reimbursements

• Plan and coordinate the development, administration and evaluation of statewide health and human services program(s)

• Serve as a resource and consultant to provide technical assistance/advice to agency staff, clients and service providers

• Research and develop program policy and perform quality assurance analysis and evaluation of assigned program(s)

• Perform related duties as assigned

Hire Rate: $24.862 per hour – non-exempt Work Schedule: 40 hours per week. Monday – Friday; 8:00 AM – 5:00 PM Dress Attire: Business Casual Location: Nebraska State Office Building – Lincoln

  Requirements / Qualifications: Minimum Qualifications: Bachelor’s degree, or equivalent coursework/training, in public administration, social/behavioral sciences, healthcare, human services or other program related field. Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement. Familiarity with Microsoft Office, Teams, Excel, PowerPoint, or similar tools.

Preferred Qualifications: • A bachelor’s degree in social sciences, education, or a related field is preferred.

• Experience with medical claims/insurance claim coordination, medical office administration.

• Experience reading/interpreting insurance policies.

Knowledge, Skills, and Abilities:

Knowledge of: the principles and practices of public administration; procedure and policy development; methods and techniques of program planning; federal and state laws, rules, regulations and procedures pertaining to health and human services programs; public funds and budgeting methods; the principles and techniques of adult learning; quality assurance mechanisms; principles and techniques of planning, monitoring and evaluating human services programs and service delivery systems.

Skill in: interpreting and/or clarifying policy to interested groups; conducting formal presentations to provide education and share information.

Ability to: plan, organize and direct a major program; work collaboratively in a team setting; analyze, develop and organize materials; establish and maintain positive relationships with agency staff, service providers/contractors, community organizations and clients; communicate electronically, on paper or in person to promote, explain, discuss, advise and interact with interested groups on various program issues and problems; prepare and review technical documents such as summaries of state and federal regulations, action plans, reports, contracts and grants; understand, interpret and apply instructions, laws, rules, policies and procedures pertinent to the program; exercise independent critical thinking skills; maintain liaison with community representatives and other governmental agencies.

  If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: https://link.nebraska.gov/

Benefits We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

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