Subrogation Specialist

MultiPlan; McLean (VA); On-site; USD 50,971,000 - 57,859,000; Full time

Benefits offered by this job

Health insurance

401k

Bonus opportunity

Job summary

Claritev is seeking a Subrogation Specialist to manage a paperless caseload, investigating recovery opportunities and coordinating with clients, members, and attorneys. The role involves high-volume outbound calls and thorough documentation within Subrogation Policies.

You will work under supervision to learn fundamentals, gather missing information, and prioritize cases while ensuring regulatory compliance and data privacy. This position offers health benefits, a 401k and a bonus opportunity.

Qualifications

• Minimum high school diploma or GED with at least one year of relevant experience.
• Proficiency with Microsoft Word and Excel; strong internet research skills.
• Excellent organizational, communication, critical thinking, analytical and independent decision making skills.

Responsibilities

• Learn and understand fundamentals of health insurance subrogation and applicable contractual provisions.
• Review and develop subrogation opportunities by gathering missing information and potential sources of recovery.
• Place parties of interest on notice.
• Organize investigations and structure them by priority using provided tools.
• Respond timely to electronic, written and verbal communications.
• Log and maintain detailed records; access client health claim systems as needed.
• Engage legal manager for proactive case resolution; ensure HIPAA compliance.

Skills

Communication

Critical thinking

Analytical

Customer service

Organization

Time management

Independent decision making

Teamwork

Education

High school diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

JOB SUMMARY:

Process a paperless health insurance subrogation caseload by investigating and developing subrogation case facts and sources of recovery. Responsibilities include placing a large volume of outbound calls as well as submitting correspondence to health plan members, insurance companies, and attorney offices. The Subrogation Specialist will coordinate efforts with other members of the subrogation team to maximize recovery in accordance with Subrogation Policies and Procedures.

JOB ROLES AND RESPONSIBILITIES:

1. Learn and understand fundamentals of health insurance subrogation, including basic health plan contractual provisions that apply to the reimbursement efforts
2. Review, Identify and develop subrogation opportunities by gathering missing information and potential sources of recovery
3. Place parties of interest on notice
4. Organize and structure investigations to work in priority order using the tools provided
5. Respond timely to all electronic, written and verbal communications
6. Log and maintain detailed and accurate records
7. Access and pull benefits from clients' health claim systems
8. Engage advice and/or help of legal manager to proactively resolve cases
9. Ensure compliance of state and federal laws
10. Provide feedback to management and unit on trends or developments
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

Performs role under direct supervision, decision making is limited in scope, follows defined structure and must be escalated if outside of scope. Must collaborate across team. Must interact with customers/clients on a regular basis and keep the needs of external and internal customers as a priority when making decisions and taking action. Must meet quality and productivity standards.

JOB REQUIREMENTS (Education, Experience, and Training)

• Minimum high school diploma or GED coupled with at least one (1) year of relevant experience.
• Working knowledge of Microsoft Word, Excel, internet research skills
• Excellent organizational, communication, critical thinking, analytical and independent decision making skills
• Developed customer service skills
• Strong organizational and time management skills
• Ability to work independently and as part of a team
• Required licensures, professional certifications, and/or Board certifications as applicable
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

COMPENSATION:

The salary for this position is $19.00 / hour. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.