Claims Recovery Specialist - Albany, NY - Hybrid

Claims Recovery Specialist - Albany, NY - Hybrid

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary: We are seeking a talented individual for a Subrogation Specialist who is responsible for processing all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, management, settlement and related functions to the case.

Your role in our mission: Ensure all processes comply with HIPAA and government security standards regarding the sharing, storage, and handling of Personal Health Information (PHI). Manage a high-volume caseload of 700–1,000 subrogation cases using advanced analytical skills to notate files, negotiate settlements, and drive recovery outcomes. Professionally engage with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients—primarily through inbound and outbound calls. Prepare and process all necessary documentation including correspondence, liens, claims, and related materials to advance cases toward resolution. Meet departmental performance standards for customer service, settlement targets, and file management guidelines. Conduct thorough document reviews to assess case status, perform legal research, and ensure timely progression through established workflows. Verify beneficiary eligibility and perform updates to case documentation as needed. Confirm and validate third-party liability, probate details, and beneficiary asset information through comprehensive research. Analyze case data from multiple sources to determine status and inform decision-making. Handle claim and lien disputes, collaborating with attorneys and stakeholders to resolve issues. Perform periodic follow-ups on case status and payment progress. Negotiate and settle claim/lien amounts in accordance with contractual guidelines. Execute and file notarized documents with county offices for applicable cases. Prioritize critical case events and revenue-impacting deadlines while maintaining compliance with internal and legal timelines. Consistently meet productivity metrics related to file handling and call volume. Strong analytical and problem-solving abilities. Proven capacity to work independently and collaboratively within a team environment. Skilled in managing multiple priorities, meeting deadlines, and performing under pressure. Exceptional attention to detail, including accuracy in cite-checking and proofreading. Professional communication skills with the ability to interact effectively across all organizational levels and with external stakeholders. Commitment to confidentiality and adherence to ethical standards.

What we're looking for: HS Diploma/GED Required. Minimum of 2 years of relevant experience. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) required. Experience in a legal office (paralegal or legal assistant) and/or in the insurance industry (casualty or health insurance) preferred. Knowledge of Medicaid and/or Medicare preferred. Basic knowledge of Microsoft Access preferred.

What you should expect in this role: This position is primarily remote; however, candidates must reside in New York State and be able to report to the Albany, NY office up to two (2) times per month for in-person meetings or training sessions as required. Ability to report to the Albany, NY office two (2) times per month for mandatory in-office days, or additionally as needed for document processing. Video cameras must be used during all interviews, as well as during the initial week of orientation. To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance. To test your internet speed, go to Google and search for "Internet Speed Test." This posting is intended for pipelining. We will accept applications on an ongoing basis.

The pay range for this position is $40,000.00 - $50,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits."