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Subrogation Recovery Specialist

Company: Cotiviti
Location: Plymouth
Posted on: November 22, 2022

Job Description:

Overview:The Subrogation Recovery Specialist is responsible for analyzing and recovering dollars related to an accident, injury, or illness in which another party is responsible. The Subrogation Recovery Specialist must work with attorneys, other health carriers, adjustors and more to both accelerate and maximize settlement amounts which will lead to savings for our clients. This position requires a combination of both oral and written communication skills combined with the ability to proficiently review healthcare claims and case documentation to deliver value and maintain a high standard of quality.Responsibilities: Effectively work, maintain and manage a variety of cases with current and accurate notes from creation to recovery Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow. Confirm documentation of eligibility for beneficiaries. Conduct all case document review and updates as needed. Confirm and validate third party liability and, probate and beneficiary asset research. Interact professionally (i.E., on incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client. Prepare required correspondence, liens, claims and other related documents to progress the case to recovery. Negotiate and compromise claim/lien settlement amounts per contract guidelines. Process all claim/lien disputes and review claims with attorneys and other stakeholders. Conduct outgoing periodic follow up on case status and payment. Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting. Compile, analyze and make conclusions about case information and status from multiple sources. Meet department objective standards for Customer Service. Complete periodic reports for management when necessary. Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).Qualifications: High School Diploma or GED required. Associate or Bachelor's degree preferred. Certified Subrogation Recovery Professional (CSRP) certification a plus. 1+ year relevant experience required (auto insurance, worker's compensation, property & casualty, claims, or health insurance). Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry is a plus. Proficiency in Microsoft Excel and Word required. Basic computer proficiency required (typing, ability to navigate various websites). Ability to analyze information and use logic to address work-related issues, problems, or opportunities. Ability to work independently to meet objectives. Ability to perform well in a team environment. Strong verbal and written communication skills. Ability to interact with all levels of people both internally and externally in a professional manner. Working knowledge of HIPAA privacy and security rules. Ability to maintain a high level of confidentiality and ethics. Working knowledge of Subrogation industry required. Ability to interpret an Explanation of Benefits (EOB), UB-04, Form 5500, Summary Plan Description (SPD), Master Plan Document (MPD), Evidence of Coverage (EOC) preferred. Medicaid and/or Medicare knowledge preferred. Bilingual (Spanish & English) a plus

Keywords: Cotiviti, Plymouth , Subrogation Recovery Specialist, Other , Plymouth, Massachusetts

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