Subrogation Specialist

BRMS•Folsom, CA

1d•$24 - $25•Onsite

About The Position

The Subrogation Specialist is responsible for subrogation activities, including the identification and research of subrogation claims. This role assists in the recovery of overpayments for duplicate coverage, workers' compensation, and no-fault claims. The Subrogation Specialist identifies legal liability and pursues, negotiates, and settles subrogation collections. This role involves researching paid claims, answering inquiries, and coordinating with other departments, insurance adjustors, attorneys, and members. Additionally, the Subrogation Specialist interacts with policyholders, claimants, witnesses, and underwriters to recommend and document the necessary information to close a file. This role also collects information needed to determine when an on-site investigation is necessary. The position requires working on-site with consistent attendance.

Requirements

Excellent customer service and interpersonal skills, both in person and over the phone
Flexibility
Dependability and maintain excellent attendance
Ability to maintain confidentiality
Ability to work well with all levels of internal management and staff as well as outside clients and vendors
Strong computer and Internet research Skills
Ability to work independently with little or no supervision
Ability to grow with changing demands of the position and the company
Great writing skills, correspondence, and phone skills
Ability to multi-task efficiently
Highly proficient in ICD-10, CPT, and HCPCS codes.
Ability to read, speak, and write effectively in English.
Ability to interpret documents such as safety rules, memos, letters, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak clearly and effectively before customers or employees of organization.
Ability to effectively address or resolve customer service issues within guidelines of the position.
Ability to add and subtract, multiply and divide with 10's and 100's.
Strong reasoning and analytical ability
Ability to interpret the highest level of understanding and logic to interpret and carry out a variety of instructions furnished in written, oral or diagram form
Ability to exercise reason and logic to resolve practical problems and create effective solutions.
Ability to analyze all relevant information and a variety of concrete variables in situations where only limited standardization exists.
Ability to decipher knowledge from one situation to a similar one and to derive appropriate solutions from learning obtained in earlier experiences.
Ability to think logically and utilize analytical reasoning.

Nice To Haves

Familiarity with subrogation processes preferred.
Legal experience a plus.
Legal Experience preferred but not required.
Health claims environment knowledge VERY helpful.

Responsibilities

Compare data on Third Party Liability Forms with policy file and other relevant company and Plan records to ascertain completeness and validity of claim and ascertain process for completion to recovery.
Contact doctors, lawyers, insurance companies, or others as may be required, to resolve claim /coverage by phone and/or written means in order to obtain necessary documentation and/or information AND to provide necessary documentation and/or information to complete recovery and close inquiry.
Compare, track and update entries made in the TPL/COB system for current status and accuracy of detail(s). Provide information to open and close these “inquiries” as well as the updates to the information stated with initials and dates as appropriate.
Work closely with Client Administration Coordinator to coordinate efforts of TPL “notices” externally. These include efforts for follow-ups internally with escalated unanswered Third-Party Liability Forms with Client Management.
Track and follow-up escalation efforts on inquiries with “special circumstances” with appropriate internal contacts, i.e. Client Management, Medical Management, Customer Support.
Receive and process Third Party Liability / Subrogation funds, allocation and appropriation. Close out Third-Party Liability case with appropriate notations / “hard” case file.
Customize existing Third-Party Liability letters to create liens, agreements and other customized legal correspondence.
Identify / review / action /pursue an appropriate Third-Party Liability – Subrogation concern/issue by opening a potentially recoverable inquiry.
Maintain a high level of customer service in all aspects of the position.
Screen calls.
Make all training meeting support copies/ arrangements.
Check deadlines on incoming / outgoing inquiries & requests.
Process replies on own initiative or notes.
Perform other duties and responsibilities as assigned by Management.