Claims Specialist

We are seeking a detail-oriented Medical Insurance Claims Specialist to join a fast-paced recovery operations team supporting health plans with subrogation and third-party liability claims. About the Role In this role, you will manage the day-to-day coordination of active insurance recovery cases, ensuring files are accurate, complete, and continuously progressing toward resolution. You will serve as a key point of contact for insurance carriers, attorneys, and external stakeholders while supporting attorneys and senior paralegals in preparing cases for negotiation and settlement. This is a high-volume, administrative-operations role ideal for candidates with experience in insurance claims, healthcare billing, revenue cycle, payer operations, workers’ compensation, or auto liability who enjoy organization, communication, and keeping complex claim portfolios moving forward. Responsibilities Manage and organize high-volume portfolios of active insurance recovery and health plan claim files. Serve as the primary contact for inbound calls and emails regarding TPL claims, liens, coverage questions, and documentation requests. Communicate professionally with external stakeholders, including plaintiff attorneys, insurance adjusters, claim representatives, carriers, and TPAs. Issue formal lien notices, confirm receipt, and follow up on missing or outstanding documentation. Audit, prepare, and maintain complete claim files to ensure accuracy and readiness for attorney review. Update and maintain real-time case notes and activity logs within claims tracking systems. Identify and elevate coverage issues, liability gaps, or missing documentation to senior team members. Track incoming reimbursement payments and flag delays or discrepancies. Support team productivity and responsiveness standards across assigned caseloads. Qualifications Associate degree required or 4+ years of equivalent industry experience. At least 2+ years of experience in one or more of the following: Insurance claims (health, auto, workers’ comp, or liability) Health plan operations or payer environments Subrogation or third-party liability (TPL) Revenue cycle / insurance follow-up Medical billing with strong insurance claims exposure Experience working directly with insurance carriers, TPAs, or liability insurers. Strong ability to manage and organize high-volume claim files or case portfolios. Excellent written and verbal communication skills. Comfortable handling external-facing communication (phone and email). Detail-oriented with strong documentation and follow-up skills. Ability to prioritize in a fast-paced, deadline-driven environment. Required Skills Prior experience in subrogation, TPL, or healthcare reimbursement environments. Familiarity with EMR systems or claims management platforms. Background in insurance recovery, legal support, or case coordination. Preferred Skills Highly organized and able to manage multiple active files at once. Proactive and resourceful in following up on missing information. Comfortable working independently while supporting a team structure. Strong communicator who can professionally interact with external partners. Resilient and adaptable in a high-volume, evolving environment. Pay range and compensation package Performance-based incentive structure in addition to base compensation. Equal Opportunity Statement As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients. #J-18808-Ljbffr