Medical Claims Recovery Specialist - Hybrid - Tucker, GA

Gainwell Technologies LLC•Any city, OH

9d•$30,500 - $43,500•Hybrid

About The Position

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others. We are seeking a talented individual for an Assistant Claims Examiner role, responsible for managing all aspects of the casualty, worker’s compensation or estate casework involving several state Medicaid beneficiaries, commercial, or deceased Medicaid beneficiaries. This role requires autonomous decision-making including resolution of disputed items, negotiation of settlement in the best interest of our clients, and independently managing a case to an effective, timely resolution.

Requirements

Minimum of 2 years of experience in the medical, insurance, legal, claims, case management, or healthcare support field required
Experience handling detailed case review, documentation, research, or case management activities required
Strong written and verbal communication skills with the ability to professionally communicate with customers, attorneys, providers, insurance carriers, and internal stakeholders require
Strong analytical, organizational, and problem-solving skills required

Nice To Haves

Experience in subrogation, casualty insurance, healthcare claims, Medicaid, Medicare, or legal support environments preferred

Responsibilities

Interact professionally in all contact with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
Effectively maintain, evaluate, and manage a variety of cases with documentation showing progression from creation to recovery.
Provide exemplary customer service with timely, relevant, and accurate information to stakeholders
Confirm and validate third party liability, probate, and beneficiary asset research.
Prepare required correspondence, liens, claims, probate filings and other related documents to progress the case to recovery.
Negotiate and compromise claim/lien settlement amounts based on the facts of each case and per contract guidelines.
Investigate all claim/lien disputes and utilize logic in determining the validity of said disputes.
Analyze and independently control a wide variety of cases of varying scope and complexity within service level agreements
Conduct outgoing follow up on case status and payment.
Perform advanced levels of document review to identify current case status, legal research, case management, and escalation as needed.
Prioritize and manage all case events and critical case payment/recovery issues, while meeting various internal and legal deadlines that are revenue impacting.