Medical Claims Recovery Specialist - Hybrid NC

Summary

Summary HMS works to make the healthcare system better for everyone. We identify and prevent fraud, waste, and abuse so individuals can access the care they need—now and in the future. Through innovative technology and powerful data analytics, we help government and commercial payers reduce costs, improve quality, and meet regulatory requirements. We also empower consumers to take a more active role in their health. Each year, we save our clients billions of dollars while supporting healthier communities.

About the role

We are seeking a detail-oriented and motivated Case Management Assistant (Onsite). This role is responsible for verifying, documenting, and coordinating information required to process applications and case management assignments. Responsibilities include confirming third-party liability, validating documentation, coordinating with employers, and providing high-quality customer service while ensuring accurate data entry, timely processing, and compliance with program requirements.

Responsibilities

• Provide enrollment support and HIPP/Premium Assistance program information to Medicaid-eligible individuals and their families via phone.
• Verify, document, and investigate healthcare coverage for Medicaid recipients and their dependents.
• Identify members who may qualify for the HIPP/Premium Assistance program.
• Complete periodic and ad-hoc reports as required.
• Handle high-volume customer service calls, including inquiries about the HIPP/Premium Assistance program.
• Perform accurate and timely data entry.
• Obtain and/or verify all documentation required for eligibility and enrollment into the HIPP/Premium Assistance program.
• Maintain active cases during open enrollment and premium review periods to support revenue and program growth.
• Independently manage a variety of cases of differing complexity within established service level agreements.
• Conduct outgoing follow-up calls regarding case status, payments, or outstanding requirements.
• Perform advanced document review, case status identification, basic legal research, and escalate issues when necessary.
• Prioritize and manage all case events and critical payment/recovery tasks while meeting internal and regulatory deadlines.
• Interact professionally with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and internal clients.

Requirements

• 2+ years of relevant professional experience in subrogation, claims, or case management.
• Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
• Experience in a legal or insurance office setting (Estate recovery or casualty preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred.

Qualifications

Your qualifications should align with the following criteria:

• Detail-oriented and motivated.
• Strong communication and customer service skills.
• Ability to handle multiple tasks and prioritize responsibilities.
• Knowledge of Medicaid and/or Medicare programs is beneficial.

Skills

• Microsoft Word and Excel proficiency.
• Basic knowledge of Microsoft Access.
• Experience in a legal or insurance office setting (Estate recovery or casualty preferred).
• Familiarity with Medicaid and/or Medicare programs.

Benefits

Gainwell offers a competitive compensation package including a base salary range of $35,500.00 - $43,500.00 per year, a hybrid work arrangement based in the Raleigh, North Carolina office, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also provide a variety of leadership and technical development academies to help build your skills and capabilities.

Pay

The pay range for this position is $35,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Schedule

Monday–Friday, 8:00 AM – 5:00 PM. A video camera is required during all interviews and throughout the first week of orientation.

Application Instructions

To apply for this position, please submit your resume and cover letter detailing your relevant experience and qualifications. Applications will be accepted on an ongoing basis.