Subrogation Negotiator

Overview

This role manages a “paperless” healthcare subrogation case load through the investigation, pending, and settlement stages of the recovery process. Work is team-oriented and involves coordinating with the team and attorneys to achieve efficient, successful outcomes.

Primary responsibilities include negotiating reimbursement of the health plan’s lien on settlement proceeds and coordinating claim payments among health plans and other responsible parties through recovery of 1st and 3rd party funds.

Please note: due to the exposure of PHI sensitive data, this role is considered a High Risk Role.

Responsibilities

• Conduct due diligence (e.g., online research, insurance verification, and court record searches) to support collections and preservation of lien rights
• Handle all aspects of the recovery process following client-specific procedures and guidelines, including maintaining a calendar diary to monitor case activity
• Provide feedback to management and unit on trends or developments
• Negotiate health plan medical claim settlements
• Identify and develop subrogation opportunities and place parties of interest on notice
• Respond timely to electronic, written, and verbal communications; log information derived from communications; maintain detailed and accurate records where required
• Research and request case information to develop cases; access and pull benefits from clients’ remote health claim systems
• Pursue recoveries including worker’s compensation, third party liability, first party uninsured and underinsured recovery, med-pay coverage, and no-fault recoveries
• Understand basic health plan contractual provisions and apply them to reimbursement efforts
• Ensure compliance with state and federal laws and settlement authority levels
• Maintain department productivity and quality standards
• Maintain sensitivity to privacy in accordance with HIPAA guidelines and ensure compliance with HIPAA regulations and requirements
• Collaborate, coordinate, and communicate across disciplines and departments
• Operate independently under limited supervision; engage legal manager input as needed to proactively resolve cases
• Keep external and internal customer needs as a priority when making decisions and taking action

Requirements

• Minimum high school diploma plus at least four (4) years’ experience in a legal environment, with three (3) years inclusive of direct experience in negotiation
• Bachelor’s degree in a relevant field is preferred
• Paralegal Certificate preferred
• Proficiency with Microsoft Word and Excel, and strong internet research skills
• Good judgment, discretion, maturity, professionalism, and razor-sharp attention to detail
• Excellent written and communication skills
• “Roll-up your sleeves” attitude and a team player mindset
• Aptitude for navigating complex issues
• Skilled at identifying and summarizing red flags/key risks
• Ability to navigate ambiguity and thrive in a fast-paced environment while juggling priorities and deadlines
• Required licensures, professional certifications, and/or Board certifications as applicable
• Ability to work in a standard office environment requiring sitting and viewing monitor(s) for extended periods, and operating standard office equipment such as a keyboard, copier, and telephone

Compensation & Benefits

• Salary range: $46K–$62K
• Offers consider education, experience, skills, work location, and internal equity
• Eligibility for health insurance, 401k, and bonus opportunity
• Benefits available may include:
  • Medical, dental, and vision coverage
  • Life and disability coverage
  • 401(k) with company match
  • Employee stock purchase plan
  • Flexible spending accounts and health savings accounts
  • Paid time off and company holidays
  • Paid parental leave
  • Mental health resources
  • Tuition reimbursement
  • Financial planning resources
  • Professional development opportunities

Location

Standard office environment; requires sitting and viewing monitor(s) for extended periods and operating standard office equipment.