Subrogation Specialist
 MultiPlan | |
 United States | |
 Apr 16, 2025 | |
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At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! Do you know someone who you think would be a great fit for this position? To share this job with someone, click the refer-a-friend icon at the top of this page. This icon is to the right of the star icon. Process a paperless health insurance subrogation caseload by investigating and developing subrogation case facts and sources of recovery. Responsibilities include placing a large volume of outbound calls as well as submitting correspondence to health plan members, insurance companies, and attorney offices. The Discovery Health Partners work environment is team-orientated. The Subrogation Specialist will coordinate efforts with other members of the subrogation team to maximize recovery in accordance with Subrogation Policies and Procedures.
JOB ROLES AND RESPONSIBILITIES:
1. Learn and understand fundamentals of health insurance subrogation, including basic health plan contractual provisions that apply to the reimbursement efforts
2. Review, Identify and develop subrogation opportunities by gathering missing information and potential sources of recovery 3. Place parties of interest on notice 4. Organize and structure investigations to work in priority order using the tools provided 5. Respond timely to all electronic, written and verbal communications 6. Log and maintain detailed and accurate records 7. Access and pull benefits from clients' health claim systems 8. Engage advice and/or help of legal manager to proactively resolve cases 9. Ensure compliance of state and federal laws 10. Provide feedback to management and unit on trends or developments 11. Collaborate, coordinate, and communicate across disciplines and departments. 12. Ensure compliance with HIPAA regulations and requirements. 13. Demonstrate Company's Core Competencies and values held within. 14. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role. 15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE:
Performs role under direct supervision, decision making is limited in scope, follows defined structure and must be escalated if outside of scope. Must collaborate across team. Must interact with customers/clients on a regular basis and keep the needs of external and internal customers as a priority when making decisions and taking action. Must meet quality and productivity standards.
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