Subrogation Specialist

Acrisure•San Diego, CA

1d•Onsite

About The Position

Acrisure is seeking an Appeal/Subrogation Specialist for our growing SBMA team. SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage. The Appeal/Subrogation Specialist is a critical member of SBMA’s Claims Department. The Appeal/Subrogation Specialist is responsible for managing and resolving appeals, coordinating subrogation opportunities, and ensuring recovery of claim costs on behalf of clients. This role requires strong analytical skills, deep understanding of claims processes, and the ability to interpret policy language, statutes, and supporting documentation. The specialist works closely with claims examiners, legal teams, carriers, vendors, and external parties to achieve accurate, timely, and compliant outcomes.

Requirements

Strong analytical skills and attention to detail.
Ability to interpret policies, regulations, and complex documentation.
Proficiency with claims management systems and Microsoft Office.
Advanced Excel and reporting skills.
Excellent verbal and written communication skills.
Ability to handle sensitive information with confidentiality.
Strong problem-solving skills and ability to think critically under pressure.
Able to work independently while coordinating with multiple departments.
2+ years of experience in claims management, appeals, subrogation, or related insurance/TPA functions.
Knowledge of claims processes.
Expert-level proficiency in HealthPac.

Nice To Haves

Experience in a TPA environment preferred

Responsibilities

Review and evaluate appeal requests to determine validity, compliance, and next steps.
Analyze claim files, medical records, payment history, EOBs, and policy/plan documents to support decision-making.
Prepare clear, thorough, and defensible written appeal determinations within regulatory timelines.
Communicate with claimants, providers, carriers, and internal departments to gather information and resolve discrepancies.
Maintain accurate documentation in the claims system and ensure all regulatory and contractual requirements are met.
Identify and evaluate potential subrogation opportunities through claim reviews, incident reports, and liability indicators.
Initiate and manage subrogation inquiries with involved parties, including adverse carriers, attorneys, employers, and vendors.
Ensure all appeal and subrogation activities comply with federal/state regulations (e.g., ERISA, state workers’ compensation laws, HIPAA).
Work closely with claims examiners, supervisors, and client service teams to support effective claim resolution.
Respond to inquiries from clients, members, providers, and external representatives with professionalism and clarity.