Job Requisition ID: 54385 BPIS: 03446 & 11758 Opening Date: 03/19/2026 Closing Date: 04/02/2026 Agency: Department of Healthcare and Family Services Class Title: MEDICAL ASSIST CONSULTANT II - 26502 Skill Option: None Bilingual Option: None Salary: Anticipated starting salary $5384/month / Full salary range $5,384 - $7,631/month Job Type: Salaried Category: Full Time County: Sangamon Number of Vacancies: 2 Bargaining Unit Code: RC062 Technical Employees, AFSCME Merit Comp Code: This position is a union position; therefore, provisions of the relevant collective bargaining agreement/labor contract apply to the filling of this position. All applicants who want to be considered for this position MUST apply electronically through the illinois.jobs2web.com website. State of Illinois employees should click the link near the top left to apply through the SuccessFactors employee career portal. Applications submitted via email or any paper manner (mail, fax, hand delivery) will not be considered. 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, Medical Programs/Bureau of Professional and Ancillary Services is seeking to hire a motivated candidate to serve as Prior Approval Specialist. Under the direction of the Prior Approval and Customer Relations/Special Case Programs managers, this position conducts professional work in the interpretation of Department policies, procedures, instructions, in the prior approval process for durable medical equipment and specialized medical services. This position will provide a current status of prior, approval requests within the MMIS database to providers of these services. The ideal candidate will possess strong communication skills, confidence, the ability to thrive in high volume and fast paced environment, and problem-solving skills to ensure operations are running effectively. 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 - Under direction, serves as a Prior Approval Specialist and conducts professional work in the interpretation of Department policies, procedures, instructions, and other related aspects regarding the Prior Approval process for durable medical equipment and specialized medical services - Responds to telephone and/or written correspondence to/from medical vendors, agency staff, and the general public regarding inquiries, complaints, and requests for information and assistance - Researches and analyzes prior approval requests submitted by medical providers to determine action for entering prior approvals - Stays up to date on policy and procedure changes - Attends meetings - 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 completion of four (4) years of college with courses in medical social work - Requires two (2) years professional experience in fields related to medical social work Preferred Qualifications - Licensure in one of the following specialties: Registered Nurse, Speech-Language Pathologist, Respiratory Therapist, Physical Therapist, or Occupational Therapist - Three (3) years of experience working with medical terminology - One (1) year of experience working with federal, state and local legislation and agency requirements pertinent to public assistance, medical care and rehabilitation assistance - One (1) year of experience providing consultation and instruction related to professional and medical social casework - One (1) year of experience providing customer service to medical provider offices on behalf of a payer - One (1) year of experience addressing policies and procedural inquiries from providers, interest groups and the general public Conditions of Employment - Requires completion of a background check and self-disclosure of criminal history - Requires the ability to utilize and maintain state issued equipment such as a laptop - The conditions of employment listed her are incorporated and related to any of the job duties as listed in the job description Work Hours: Monday - Firday 8:30am - 5:00pm Headquarter Location: 201 S Grand Ave E, Springfield, Illinois, 62704 Work County: Sangamon Agency Contact: HFS.DMPApps@illinois.gov Posting Group: Health Services This position DOES NOT contain “Specialized Skills” (as that term is used in CBAs). APPLICATION INSTRUCTIONS Use the “Apply” button at the top right or bottom right of this posting to begin the application process. If you are not already signed in, you will be prompted to do so. State employees should sign in to the career portal for State of Illinois employees – a link is available at the top left of the Illinois.jobs2web.com homepage in the blue ribbon. Non-State employees should log in on the using the “View Profile” link in the top right of the Illinois.jobs2web.com homepage in the blue ribbon. If you have never before signed in, you will be prompted to create an account. If you have questions about how to apply, please see the following resources: State employees: Log in to the career portal for State employees and review the Internal Candidate Application Job Aid Non-State employees: on Illinois.jobs2web.com – click “Application Procedures” in the footer of every page of the website. 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

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Liability (REMOTE - Water Damage Claims Exp) - 3-5 years Water damage claim handling experience. - Experience with mitigation/remediation estimate reviewal. - Xactimate estimating experience required. - Product Liability experience preferred however not required. - Strong negotiating skills essential Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. - Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. - Enjoy flexibility and autonomy in your daily work, your location, and your career path. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. - Assesses liability and resolves claims within evaluation. - Negotiates settlement of claims within designated authority. - Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience: Five (5) years of Liability claims management experience or equivalent combination of education and experience required. TAKING CARE OF YOU - Flexible work schedule. - Referral incentive program. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

• To analyze mid- and higher-level general liability claims to determine benefits due. • Ensure ongoing adjudication of claims within company standards and industry best practices. • Identify subrogation of claims and negotiate settlements. • Manages mid-level general liability claims by gathering information to determine liability exposure. • Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. • Assesses liability and resolves claims within evaluation. • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. • Manages subrogation of claims and negotiates settlements.

The Claims Intake Specialist supports the Claims team by managing incoming claim-related correspondence, organizing electronic claim files, and assisting claims professionals with administrative and document preparation needs. This role is highly detail-oriented and helps ensure claim documentation is processed accurately, timely, and in accordance with internal workflows—while contributing to continuous process improvement. Essential Responsibilities - Sort, order, index, and file claim-related mail received via email. - Claim set up. - Create and organize ImageRight folders/zip folders as needed to support claim file structure and accessibility. - Draft documents and provide administrative and operational support to claims professionals. - Assist with special projects and other duties as needed due to business change and growth. - Participate in continuous claims process and operational improvement efforts, including identifying workflow efficiencies and supporting implementation of improvements. Qualifications - 3+ years of administrative support experience. - Insurance industry (Claims) experience is a plus, but not required. - Highly organized and efficient in a fast-paced, multi-task environment; able to prioritize effectively to accomplish objectives with creativity and enthusiasm. - Working knowledge of Microsoft Office applications (e.g., Outlook, Word, Excel). - Ability to work well with people in a high-performing environment, supporting teamwork and collaboration. Key Skills & Attributes (Preferred) - Strong attention to detail and commitment to accuracy. - Professional written communication and document formatting skills. - Ability to manage repetitive tasks while maintaining quality and speed. - Customer-service mindset when supporting internal stakeholders. Compensation & Benefits The applicable base salary for this opportunity is $50,000 - $60,000. The base pay offered will be determined by factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. In addition to the base salary, this opportunity may be eligible for performance-based incentives.​ We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition and professional certification assistance, 401k savings, elective participation in the Employee Stock Purchase Program, paid time off, paid holidays, and child bonding leave, as well as other employee assistance.