Claims Recovery Specialist

2 weeks ago

Atlanta, Georgia, United States MultiPlan Full time

Company Overview: At MultiPlan, we are a vibrant collective of forward-thinking professionals dedicated to reshaping the landscape of healthcare costs. Our mission is straightforward: we aim to transform the cost dynamics in healthcare for everyone involved. Our commitment to excellence in service resonates with all our stakeholders, driving us to surpass expectations consistently. We embrace boldness, foster innovation, nurture accountability, champion diversity, and empower one another to realize our shared potential.

Position Summary: This role serves as a hybrid function within the Shared Services for Subrogation. The Subrogation Analyst will engage in three core responsibilities that will rotate based on business needs and directives from the Subrogation leadership team. This position entails managing a high volume of incoming calls to handle a digital health insurance subrogation caseload by investigating potential cases and pursuing recoveries related to medical payments, no-fault claims, liability, and workers' compensation.

Key Responsibilities:

  1. Adhere to client-specific protocols and ensure compliance with state and federal regulations.
  2. Identify and cultivate subrogation opportunities, including initiating new cases through various communication channels, such as a high-volume call center and a centralized digital mailroom.
  3. Conduct outbound communications with law firms and insurance entities to gather case information, develop cases, and notify relevant parties.
  4. Provide call center support as needed by handling inbound inquiries and documenting cases accurately.
  5. Respond promptly to all forms of communication, maintaining detailed and accurate records, and managing a calendar diary to track case activities.
  6. Assess case viability and discontinue pursuit when appropriate.
  7. Maintain meticulous case records and calendar diaries to monitor activities and meet departmental expectations.
  8. Uphold departmental productivity and quality benchmarks.
  9. Collaborate and communicate effectively across various disciplines and departments.
  10. Exhibit flexibility to transition between primary tasks to meet current business needs and engage in additional projects as assigned by Subrogation leadership.
  11. Ensure adherence to HIPAA regulations and requirements.
  12. Demonstrate the company's core competencies and values.
  13. Note that due to the handling of sensitive data, this role is classified as a High-Risk Role.
  14. Seek guidance from Management to proactively resolve cases and provide feedback on trends or developments.
  15. The responsibilities outlined above are not exhaustive; additional duties and qualifications may be assigned as necessary.

Job Scope: The incumbent operates under general supervision, prioritizing the needs of both external and internal customers in decision-making and actions. The role involves communication with a diverse client base, members, and their employers. A successful candidate will be receptive to feedback, work collaboratively, and show a strong interest in contributing ideas to enhance existing departmental processes. This position is multi-functional, requiring the ability to manage multiple projects simultaneously. Decision-making is guided by established protocols and may often require escalation to higher management levels.

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