Claims Recovery Specialist - Albany, NY - Hybrid

About the role

We are seeking a talented individual for a Subrogation Specialist who is responsible for processing all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, management, settlement and related functions to the case.

Responsibilities

• Ensure all processes comply with HIPAA and government security standards regarding the sharing, storage, and handling of Personal Health Information (PHI).
• Manage a high-volume caseload of 700–1,000 subrogation cases using advanced analytical skills to notate files, negotiate settlements, and drive recovery outcomes.
• Professionally engage with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients—primarily through inbound and outbound calls.
• Prepare and process all necessary documentation including correspondence, liens, claims, and related materials to advance cases toward resolution.
• Maintain departmental performance standards for customer service, settlement targets, and file management guidelines.
• Conduct thorough document reviews to assess case status, perform legal research, and ensure timely progression through established workflows.
• Verify beneficiary eligibility and perform updates to case documentation as needed.
• Confirm and validate third-party liability, probate details, and beneficiary asset information through comprehensive research.
• Analyze case data from multiple sources to determine status and inform decision-making.
• Handle claim and lien disputes, collaborating with attorneys and stakeholders to resolve issues.
• Perform periodic follow-ups on case status and payment progress.
• Negotiate and settle claim/lien amounts in accordance with contractual guidelines.
• Execute and file notarized documents with county offices for applicable cases.
• Prioritize critical case events and revenue-impacting deadlines while maintaining compliance with internal and legal timelines.
• Consistently meet productivity metrics related to file handling and call volume.
• Strong analytical and problem-solving abilities.
• Proven capacity to work independently and collaboratively within a team environment.
• Skilled in managing multiple priorities, meeting deadlines, and performing under pressure.
• Exceptional attention to detail, including accuracy in cite-checking and proofreading.
• Professional communication skills with the ability to interact effectively across all organizational levels and with external stakeholders.
• Commitment to confidentiality and adherence to ethical standards.

Requirements

• High School Diploma/GED Required.
• Minimum of 2 years of relevant experience.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) required.
• Experience in a legal office (paralegal or legal assistant) and/or in the insurance industry (casualty or health insurance) preferred.
• Knowledge of Medicaid and/or Medicare preferred.
• Basic knowledge of Microsoft Access preferred.

Qualifications

• This position is primarily remote; however, candidates must reside in New York State and be able to report to the Albany, NY office up to two (2) times per month for in-person meetings or training sessions as required.
• Ability to report to the Albany, NY office two (2) times per month for mandatory in-office days, or additionally as needed for document processing.
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• To test your internet speed, go to Google and search for “Internet Speed Test.”

Benefits

• The pay range for this position is $40,000.00 - $50,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Pay

This posting is intended for pipelining. We will accept applications on an ongoing basis.

The pay range for this position is $40,000.00 - $50,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.