Legal Case Manager

Overview

This role serves as a critical compliance and operational resource responsible for reviewing, researching, validating, and processing requests involving member Protected Health Information (PHI). Responsibilities focus on ensuring compliance with HIPAA, applicable state privacy laws, regulatory requirements, and organizational policies before any access, use, or disclosure of records occurs.

Responsibilities

• Review, research, and process requests for member claims records involving Protected Health Information (PHI), ensuring compliance with HIPAA, state privacy laws, company policies, and regulatory requirements.
• Process and fulfill requests submitted to Aetna seeking access to member PHI, ensuring required legal, regulatory, privacy, and authorization requirements are satisfied before disclosure.
• Review and validate request documentation to determine eligibility for disclosure and confirm compliance with applicable federal and state regulations.
• Manage and process requests received through:
  • Subpoenas and court orders
  • Law enforcement requests and demands
  • Regulatory agency inquiries and requests
  • Legal Access requests
  • Member and provider authorizations
  • Personal representative requests
  • Other legally permitted disclosures of PHI
• Research and resolve complex or non-routine member rights, disclosure, and privacy requests, escalating matters requiring legal, compliance, or privacy review.
• Ensure confidentiality and security of sensitive member information while adhering to established policies, procedures, and internal controls.

Required Qualifications

• Working knowledge of problem solving and decision making skills
• 2–5+ years’ work experience with Protected Health Information (PHI)
• Excellent verbal and written communication skills

Preferred Qualifications

• Working knowledge of HIPAA Privacy Rule requirements
• Experience reviewing and interpreting legal documents, subpoenas, court orders, authorizations, and regulatory correspondence

Education

• High School Diploma or Equivalent Experience (REQUIRED)

Compensation & Benefits

• Pay range: $18.50 - $38.82 (typical pay range for this role)
• Actual base pay offer depends on factors including experience, education, geography, and other relevant factors.
• This position is eligible for a bonus, commission, or short-term incentive program in addition to the base pay range listed above.
• Full-time benefits may include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources (eligibility required).

Location

• Not specified

Additional Information

• Anticipated weekly hours: 40
• Time type: Full time
• Application window closing date: 09/11/2026
• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.