Senior Claim Recovery Specialist
New
J
JobgetherHealthcare benefits
Based in the United StatesFull-TimeSenior
Salary50,000 - 65,000 USD per year
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Job Details
- Languages
- Ability to read, write, and speak English. Bilingual proficiency is preferred but not required.
- Experience
- One to three years of experience in subrogation, claims recovery, reimbursement, or a related field.
- Required Skills
- Microsoft ExcelNegotiation
Requirements
- Have one to three years of experience in subrogation, claims recovery, reimbursement, or a related field.
- Understand recovery opportunities, reimbursement processes, insurance coverage, and how to identify responsible payers.
- Assess recovery potential and determine appropriate reimbursement approaches based on evidence and plan provisions.
- Communicate professionally with attorneys, adjusters, plan participants, and clients, verbally and in writing.
- Define problems, collect and evaluate information, interpret relevant case law, and draw valid conclusions.
- Manage a large caseload, prioritize competing tasks, meet deadlines, and maintain accuracy on time-sensitive documents.
- Be familiar with Microsoft Word, Excel, Outlook, standard office equipment, and document-processing tools.
- Protect sensitive health and claims information and comply with HIPAA requirements.
- Read, write, and speak English; bilingual proficiency is preferred but not required.
- Pass applicable departmental assessments, including qualification tests administered by the department manager.
- Work effectively in a fast-paced office environment involving extended workstation time, extensive computer use, and regular operation of office equipment.
- An associate degree or higher is preferred; a paralegal certificate is preferred but not required.
Responsibilities
- Manage recovery files from initial review through resolution, identifying opportunities to recover medical expenses from appropriate third parties.
- Investigate potential reimbursement sources, including automobile insurance, workers’ compensation, and first-party or third-party coverage.
- Contact insurance carriers to obtain claim details and contact information.
- Follow up with attorneys and adjusters, obtain case updates, and negotiate recovery matters.
- Review health benefit plan documents to identify applicable exclusions, recovery rights, and reimbursement obligations.
- Communicate with plan sponsors, employers, and claims administrators by telephone and email, responding to inquiries and reduction requests.
- Draft, prepare, mail, and fax correspondence and other case-related documents.
- Maintain and prioritize a substantial caseload, track deadlines, and follow up on outstanding matters.
- Use Microsoft Word, Excel, Outlook, and other relevant applications to organize case information and maintain accurate records.
- Protect sensitive information, maintain confidentiality, and follow HIPAA requirements.
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