Subrogation Case Specialist

1 month ago

Atlanta, Georgia, United States MultiPlan Full time

About MultiPlan:

At MultiPlan, we take pride in our dynamic team of innovative professionals. Our mission is straightforward - we aim to transform the cost landscape in healthcare for everyone. Our commitment to excellence in service extends to all stakeholders, both internal and external, driving us to consistently surpass expectations. We are intentionally bold, fostering innovation, nurturing accountability, championing diversity, and empowering one another to unlock our collective potential.

Position Overview:

This role is pivotal in developing cases following the initial assessment to confirm the viability of subrogation claims. The incumbent will oversee the coordination of claim payments among health plans, recover duplicate payments from providers, and ensure successful recovery of first-party funds. The position requires the individual to provide a conclusive determination on all potential recovery sources and thoroughly prepare cases for Paralegals to negotiate liability claims effectively. Confidence in phone interactions and comfort in engaging with insurance companies, providers, health plan members, and personal injury attorneys is essential.

Key Responsibilities:

  1. Review, identify, and cultivate subrogation opportunities by gathering necessary information and potential recovery sources. Conduct thorough research and analysis of the information collected through ongoing investigations. Maintain detailed and accurate records.
  2. Assess claim viability and discontinue pursuit when appropriate; respond promptly to all forms of communication.
  3. Notify interested parties and issue subsequent demand letters.
  4. Engage in continuous research and make proactive calls to gather case information or status updates to facilitate settlements; keep detailed and accurate case records and calendars to track case activities in line with departmental expectations.
  5. Collaborate with Negotiators/Paralegals to proactively resolve or transfer cases as needed.
  6. Ensure adherence to state and federal regulations while maintaining departmental productivity and quality standards.
  7. Handle transferred calls and documents from inbound investigation teams to provide resolutions to inquiries.
  8. Work collaboratively across various disciplines and departments.
  9. Comply with HIPAA regulations and requirements.
  10. Exemplify the Company's Core Competencies and values.
  11. Note: Due to exposure to sensitive data, this role is classified as a High-Risk Role.
  12. The responsibilities outlined above are not exhaustive; additional duties and qualifications may be assigned as necessary.

Job Scope:

This role prioritizes the needs of both external and internal customers when making decisions and taking actions. The successful candidate will operate independently with limited supervision, possessing decision-making authority within specified parameters. Collaboration with legal managers, negotiators, or paralegals is essential to proactively resolve cases while maintaining positive relationships with customers, beneficiaries, providers, and supplemental payors.

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