Subrogation Specialist

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

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.

DUTIES

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 and 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.

COMPENSATION

The hourly rate for this position is $19 per 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 opp

REQUIREMENTS

• 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

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• Paid Parental Leave
• 401(k) + match
• Employee Stock Purchase Plan
• Generous Paid Time Off – accrued based on years of service
• WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
• 10 paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

EEO STATEMENT

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status.

APPLICATION DEADLINE

We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.

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