Subrogation Specialist

SUMMARY

Subrogation Specialist is responsible for subrogation activities including the identification and research of subrogation claims. Assists in the recovery of overpayments for duplicate coverage, workers' compensation, and no-fault claims. Being a Subrogation Specialist identifies legal liability and pursues, negotiates, and settles subrogation collection. Research paid claims, answers inquiries, and coordinates with other departments, insurance adjustors, attorneys, and members. Additionally, Subrogation Specialist interacts with policyholders, claimants, witnesses, and underwriters to recommend and document the necessary information to close a file. Collects information needed to determine when an on-site investigation is necessary.

DESCRIPTION

Subrogation Specialist is responsible for subrogation activities including the identification and research of subrogation claims. Assists in the recovery of overpayments for duplicate coverage, workers' compensation, and no-fault claims. Being a Subrogation Specialist identifies legal liability and pursues, negotiates, and settles subrogation collection. Research paid claims, answers inquiries, and coordinates with other departments, insurance adjustors, attorneys, and members. Additionally, Subrogation Specialist interacts with policyholders, claimants, witnesses, and underwriters to recommend and document the necessary information to close a file. Collects information needed to determine when an on-site investigation is necessary.

ESSENTIAL DUTIES AND RESPONSIBILITIES

include the following. Other duties may be assigned. Works on site with consistent attendance. Claims Administration/TPL – Subrogation Compare data on Third Party Liability Forms with policy file and other relevant company and Plan records to ascertain completeness and validity of claim and ascertain process for completion to recovery. Contacts doctors, lawyers, insurance companies, or others as may be required, to resolve claim /coverage by phone and/or written means in order to obtain necessary documentation and/or information AND to provide necessary documentation and/or information to complete recovery and close inquiry. Compares, tracks and updates entries made in the TPL/COB system for current status and accuracy of detail(s). Provides information to open and close these “inquiries” as well as the updates to the information stated with initials and dates as appropriate. Works closely with Client Administration Coordinator to coordinate efforts of TPL “notices” externally. These include efforts for follow-ups internally with escalated unanswered Third-Party Liability Forms with Client Management. Must be able to track and follow-up escalation efforts on inquiries with “special circumstances” with appropriate internal contacts, i.e. Client Management, Medical Management, Customer Support. Receive and process Third Party Liability / Subrogation funds, allocation and appropriation. Close out Third-Party Liability case with appropriate notations / “hard” case file. Must be able to customize existing Third-Party Liability letters to create liens, agreements and other customized legal correspondence. Works to identify / review / action /pursue an appropriate Third-Party Liability – Subrogation concern/issue by opening a potentially recoverable inquiry. Client Administration Maintains a high level of customer service in all aspects of the position. Screens calls. Makes all training meeting support copies/ arrangements. Checks deadlines on incoming / outgoing inquiries & requests. Processes replies on own initiative or notes. Performs other duties and responsibilities as assigned by Management. Requirements Knowledge, Skills, & Abilities Excellent customer service and interpersonal skills, both in person and over the phone Flexibility a must Must be dependable and maintain excellent attendance Familiarity With Subrogation Processes Preferred. Legal Experience a Plus. Ability to maintain confidentiality Ability to work well with all levels of internal management and staff as well as outside clients and vendors Strong computer and Internet research Skills Ability to work independently with little or no supervision Ability to grow with changing demands of the position and the company Must have great writing skills, correspondence, and phone skills Ability to multi-task efficiently Must be highly proficient in ICD-10, CPT, and HCPCS codes. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education And/or Experience High school or G.E.D. equivalent; and minimum of three years of increasingly responsible office administrative support, specialized administrative support or secretarial experience and/or training; or equivalent combination of education and experience. Legal Experience preferred but not required. Health claims environment knowledge VERY helpful. Language Skills Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, memos, letters, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak clearly and effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills Ability to add and subtract, multiply and divide with 10's and 100's. Reasoning Ability Strong reasoning and analytical ability, including: Ability to interpret the highest level of understanding and logic to interpret and carry out a variety of instructions furnished in written, oral or diagram form Ability to exercise reason and logic to resolve practical problems and create effective solutions. Ability to analyze all relevant information and a variety of concrete variables in situations where only limited standardization exists. Ability to decipher knowledge from one situation to a similar one and to derive appropriate solutions from learning obtained in earlier experiences. Ability to think logically and utilize analytical reasoning. Certificates, Licenses, Registrations n/a Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. #J-18808-Ljbffr BRMS