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NYS Department of Civil Service

Resources & Reimbursement Agent 1/Trainee 1&2 (NYS HELPS), Central Office;

Career Insights for Claims Examiner (General)

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What they do

A Claims Examiner evaluates insurance claims in accordance with applicable contracts and government regulations within their insurance type. Determines member eligibility and financial responsibility of the insurance company.

$85,722 / year median in New York

-0% projected decline

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Job Description

Date Posted:
08/21/26
Applications Due:
09/07/26
Vacancy ID:
222252 Position Information NY HELPYes AgencyMental Health, Office of TitleResources & Reimbursement Agent 1/Trainee 1&2 (NYS HELPS), Central Office; Occupational CategoryFinancial, Accounting, Auditing Salary Grade18 Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF) Salary RangeFrom $53764 to $66951 Annually Employment TypeFull-Time Appointment TypePermanent Jurisdictional ClassCompetitive Class Travel Percentage0% Schedule WorkweekMon-Fri Hours Per Week37.5 Workday From8 AM To12 AM Flextime allowed?

No Mandatory overtime?

No Compressed workweek allowed?

No Telecommuting allowed?

Yes Location CountyOnondaga Street AddressNYS Office of Mental Health 625 Madison Street CitySyracuse StateNY Zip Code13210 Job Specifics Duties DescriptionThe Office of Mental Health is recruiting for a Resources & Reimbursement Agent 1/Trainee in the State Operations Finance Group. Reporting to a Resource & Reimbursement Agent 3, G-23, the incumbent will support the RRA3 in maintaining a caseload of inpatients, outpatients, and residential clients, developing reimbursement for New York State OMH facilities and developing entitlements for individuals served by OMH. Responsibilities include but are not limited to:
  • Investigate, develop and protect clients' financial resources.
  • Investigate disability, medical and hospital benefits, and insurance coverage and determine ability to pay.
  • Acquire knowledge about all reimbursement and program sources available to recipients of OMH services such as Medicare, Medicaid, health insurance, Social Security, Veteran's Administration, Food Stamps and other government programs as well as private ability to pay.
  • Acquire knowledge about and be able to access and use OMH, Medicaid and other benefit and insurance related computer applications.
  • Review and discuss with patients/clients, their families, attorneys, and other interested parties concerning clients' finances.
  • Set charges and ensure that reserves and adequate spending allowances are maintained.
  • Work with OMH facilities and community residences regarding financial aspects of client support systems; and interact with other agencies such as Social Security, local Department of Social Services and billing intermediaries.
Minimum QualificationsNon-Competitive HELPS:
Trainee 1 ($53,764): Four years of experience conducting financial reviews and evaluations, determining payment sources, and developing and submitting claims for health care and treatment costs. Trainee 2 ($59,994): Five years of experience conducting financial reviews and evaluations, determining payment sources, and developing and submitting claims for health care and treatment costs. Journey Level ($66,951): Six years of experience conducting financial reviews and evaluations, determining payment sources, and developing and submitting claims for health care and treatment costs.
  • Associate degree may substitute for two years of specialized experience; bachelor's degree may substitute for four years of specialized experience; master's degree may substitute five years of specialized experience; J.
D. may substitute for six years of specialized experience. 55
BC Opportunity:
Must meet the Non-Competitive minimum qualifications above and Individuals certified eligible for the 55b/c program under the Governor's Program to Hire Persons/Veterans with Disabilities pursuant to Section 55b/c of the Civil Service Law AND possess a Bachelor's degree will also be considered. Please provide a copy of your eligibility letter and transcript with your response.
Transfer Opportunity:
Candidates must have permanent status as a Resources & Reimbursement Agent 1, SG-18 and be eligible for lateral transfer; OR be eligible to transfer via Section 70.1 or Section 52.6 of the Civil Service Law by having at least one year of permanent service in a qualifying title within two salary grades of this position. Additional CommentsEmployment with New York State offers unmatched benefits, individual support, and career mobility for motivated individuals including: NYS pension and retirement programs; annual cost of living and performance advance increases; comprehensive medical, dental, and vision plans; flexible spending accounts for health and dependent care; paid time off, including thirteen paid holidays per year, and paid personal leave, vacation leave, and sick leave. Specific scheduled hours and telecommuting availability for this position will be discussed during the interview process. Please note, employees are required to apply and obtain approval through management to telecommute according to operational needs and Agency Telecommuting Program Guidelines. The Mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer. This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). For the duration of NY HELPS, this title maybe filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply. At a future date, it is expected that employees hired under
NY HELPS
will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all of the same rights and privileges of competitive class employees of New York State. While serving permanently in a
NY HELPS
title, employees may take part in any promotion examination for which they are qualified. Some positions may require additional credentials or a background check to verify your identity. How to Apply NameCiara Pelham Telephone Fax(518) 486-3897 Email AddressOMHHRM@OMH.NY.GOV Address StreetNYS Office of Mental Health 44 Holland Avenue CityAlbany StateNY Zip Code12229 Notes on ApplyingTo be considered for this position, interested candidates should email a cover letter and resume in Microsoft Word or PDF format to omhhrm@omh.ny. Please include the title of the position and Vacancy ID #222252 in the subject line of your email when applying. You are advised that, should you accept a job offer with the Office of Mental Health, you may be required to be fingerprinted and pay a fingerprint fee.