Medical Claims Processor

Claims Processing Specialist - 36000297

The State Personnel System is an E-Verify employer. Requisition No: 880595 Agency: Department of Lottery Working Title: Claims Processing Specialist - 36000297 Pay Plan: Lottery Exempt Serv Position Number: 36000297 Salary: $37,208.76 Posting Closing Date: 08/12/2026

Agency Benefits: If hired, as employee of the Florida Lottery, you will be provided the benefits listed below:

• Approximately 97.5% of the premium for health insurance Individual (~$8/month) or Family (~$30/month)
• 100% of the premium for individual or family dental insurance
• 100% of the premium for basic life insurance
• Employer contributions to the Pension Plan or Investment Plan; contribution levels will vary based upon Pay Plans.

General Position Description: This is a professional position requiring the use of independent judgment to perform audit-style tasks and accounting functions, validate prizes, initiate prize payments, and provide customer service to players via phone and email. Under the direction of a supervisor, the incumbent assigned to this position is responsible for carrying out the duties described below in accordance with established policies and procedures.

Essential Duties:

• Provide support to all internal and external customers.
• Analyze, validate, and pay claims and/or tickets submitted to Lottery Headquarters, utilizing a proprietary prize payment software system.
• Review and process claims/tickets presented for payment ensuring compliance with established prize payment rules, policies and procedures.
• Review claim documentation for all required elements of eligibility and IRS tax reporting information ensuring the correct amount paid, withheld, remitted, and reported correctly.
• Review and process any state-owed debt claims that result from the validation process. These debts must be verified, withheld, and then forwarded to the appropriate agency in a timely fashion to ensure minimal disruption for winners.
• Prepare and maintain prize payment claim files.
• Answer phone calls from players and utilize customer service skills to provide a positive customer experience.
• Assist as requested with any special promotion or game draws assigned.
• Assist with Quarterly Audits of the Claims Processing Secured Cage.
• Provide support to Internal and External customers.
• Assist District staff in resolving issues arising during the payment process, which may include receiving copies of documentation, verifying amounts and/or printing checks.
• Conduct all Lottery business in a professional manner with emphasis being placed on winner convenience and satisfaction.
• Initiate correspondence when necessary to communicate issues effectively with customers to provide a timely resolution of processing problems.
• Assist with training of other team members within Claims Processing.
• Assist in drafting and implementing procedures for Claims Processing.
• Crosstrain with other teams within Claims Processing.
• Analyze and resolve problem claims.
• Review, analyze and follow-up on pending claims, initiating management reviews as deemed necessary.
• Audit paid claims to ensure prizes were paid in compliance with the Lottery's rules, policies and procedures.
• Research and resolve checks returned as undeliverable by the postal service.
• As directed, assist in scanning paid claim files and other documents, with the Lottery's document management software.
• Perform functions necessary to process scratch off and online winners.
• Create, maintain, modify, and manage computer data files using a variety of software applications.
• As directed, participate in unit sub-groups designed to improve processes, find efficiencies, and increase overall performance.

Knowledge, Skills, and Abilities:

• Knowledge of customer service techniques.
• Knowledge of general accounting practices, bookkeeping practices, and basic business administration.
• Knowledge of office procedures and practices.
• Knowledge of Word, Excel, and Outlook.
• Ability to prepare and maintain a variety of records.
• Ability to plan, organize and coordinate work assignments.
• Ability to analyze and report accounting data.
• Ability to provide effective written and verbal business communications.
• Ability to effectively use office equipment and agency computer systems to complete assigned work accurately and efficiently.
• Ability to work independently, and to solve problems and make decisions.
• Ability to read and interpret procedures and technical manuals.
• Ability to multi-task, prioritize workload and manage time effectively while meeting deadlines.
• Ability to sit for extended periods of time (up to 4-6 hours daily) while performing computer-based tasks.

Other job-related requirements for this position:

• High School Diploma or equivalent (GED) required.
• Successful passing of a criminal background check (state, local, and national) is required.
• Maintains strict confidentiality of information learned while working with the Florida Lottery, whether learned through assigned duties or through working with other units.

Statutes establishing or defining work performed Chapter 24, Florida Statutes

Work Hours Total hours in workweek: 40

Location: Tallahassee, FL, US, 32301