Case Development Specialist - Health Insurance Plan Recovery

Case Development Specialist Healthcare Recovery

The Case Development Specialist Healthcare Recovery reviews inbound referrals and manually screens claims data to identify potential reimbursement and subrogation opportunities for Intellivo's clients. This role focuses on intake, validation, and case setupensuring that only high-quality, recoverable matters move forward to downstream recovery and legal teams. You will analyze medical claims, property & casualty (P&C) referrals, and related documentation to determine recovery potential, clarify facts, and accurately create cases in internal systems.

This role is ideal for candidates with backgrounds in insurance claims intake, medical billing, revenue cycle operations, or payer intake functions who enjoy investigative review, accuracy-driven work, and high-impact decision-making.

Responsibilities:

• Review inbound referrals, accident reports, and insurer-supplied data for recovery potential
• Manually screen healthcare claims and P&C information to identify third-party liability or reimbursement opportunities
• Apply intake rules and guidelines to determine case creation, closure, or escalation
• Distinguish recoverable accident-related scenarios from non-recoverable or low-value claims

Case Setup & Data Entry:

• Create and update cases in internal systems with accurate parties, injury details, and claim data
• Capture and summarize referral facts for recovery and legal teams
• Assign case types, priorities, and attributes based on client requirements

Information Gathering & Coordination:

• Request additional documentation from carriers, TPAs, attorneys, or internal teams to validate referrals
• Document decisions and intake rationale clearly
• Escalate complex or borderline cases to subject-matter experts

Qualifications:

• 13 years' experience in insurance claims intake, medical billing, revenue cycle, payer operations, or data-review roles
• Associate's or Bachelor's degree preferred (or equivalent experience)
• Familiarity with healthcare claims, P&C data, TPL, or subrogation a plus
• Strong attention to detail and investigative mindset
• Comfortable performing high-volume manual review across multiple systems
• Proficiency with Microsoft Office
• Organized and able to manage intake queues independently
• Collaborative and comfortable escalating questions

Who is Intellivo?

As an industry market leader in subrogation, Intellivo empowers health plans and insurers to maximize financial outcomes by identifying and pursuing more reimbursement opportunities from alternative third-party liability (TPL) payers. Through innovative technology, Intellivo accelerates the identification of reimbursement opportunities while completely eliminating the need to fill information gaps through ineffective and burdensome outreach to plan members. With a 25-year history of excellence, Intellivo proudly serves more than 200 of the country's largest health plans.

Why work for Intellivo?

• Amazing Team Members Intellivators!
• Medical Insurance
• Dental & Vision Insurance
• Industry leading health & wellness benefits
• 401(K) retirement plan
• Competitive Paid Time Off
• And More!