Subrogation Negotiator

JOB SUMMARY: This role manages a "paperless" healthcare subrogation case load through investigation, pending and settlement stages of the recovery process. The work environment is team oriented; the incumbent will coordinate efforts with the team and attorneys to bring matters to efficient and successful outcomes. The incumbent's primary responsibility will be negotiating reimbursement of the health plan's lien on settlement proceeds and is accountable for managing the coordination of claim payments among health plans and other responsible parties through recovery of 1st and 3rd party funds.

JOB ROLES AND RESPONSIBILITIES:

1. Conduct due diligence (e.g. online research, insurance verification, and court record searches) to assist with collections and preservation of lien rights
2. Work all aspects of the recovery process following client specific procedures and guidelines, and maintain a calendar diary to monitor case activity, and provide feedback to management and unit on trends or developments
3. Negotiate health plan medical claim settlements
4. Identify and develop subrogation opportunities and place parties of interest on notice
5. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; where required maintain detailed and accurate records
6. Research and request case information to develop cases, access and pull benefits from clients' remote health claim systems
7. Pursue worker's compensation, third party liability, first party uninsured and underinsured recovery, worker's compensation, med-pay coverage and no-fault recoveries.
8. Understand basic health plan contractual provisions and apply to the reimbursement efforts, ensure compliance of state and federal laws and settlement authority levels
9. Maintain department productivity and quality standards
10. Sensitivity to privacy in accordance with HIPAA guidelines
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE: Keep the needs of external and internal customers as a priority when making decisions and taking action. Operates independently under limited supervison. Has decision making authority within specified parameters and must Engage advice and/or help of legal manager to proactively resolve cases. Works across customers, beneficiaries, providers, and suplimental payors while maintaining positive relationships.

JOB REQUIREMENTS (Education, Experience, and Training):

1. Minimum high school diploma coupled with at least four (4) years' experience in a legal environment, three (3) of which should be inclusive of direct experience in negotiation. Bachelors' degree in a relevant field is preferred.
2. Paralegal Certificate Preferred
3. Proficiency with Microsoft Word, Excel, internet research skills
4. Good judgment, discretion, maturity, professionalism, and razor-sharp attention to detail.
5. Excellent written and communication skills.
6. A "roll-up your sleeves" attitude, and team player mindset are must haves for this position.
7. Aptitude for navigating complex issues.
8. Skilled at identifying and summarizing red flags/key risks.
9. Ability to navigate through ambiguity and thrive in a fast-paced, dynamic environment while juggling priorities and deadlines.
10. Required licensures, professional certifications, and/or Board certifications as applicable.
11. Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

COMPENSATION:

The salary range for this position is 46K-62K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.