Subrogation Specialist

About the role

The Subrogation Specialist is responsible for subrogation activities including the identification and research of subrogation claims. They assist in the recovery of overpayments for duplicate coverage, workers' compensation, and no-fault claims. This role involves identifying legal liability, pursuing, negotiating, and settling subrogation collection. The Subrogation Specialist also researches paid claims, answers inquiries, and coordinates with various departments, insurance adjustors, attorneys, and policyholders.

Responsibilities

• Works on-site with consistent attendance.
• Compares data on Third Party Liability Forms with policy files and other relevant company and Plan records to ascertain completeness and validity of claims and ascertain process for completion to recovery.
• Contacts doctors, lawyers, insurance companies, or others as may be required to resolve claims/covers by phone and/or written means in order to obtain necessary documentation and/or information AND to provide necessary documentation and/or information to complete recovery and close inquiry.
• Compares, tracks, and updates entries made in the TPL/COB system for current status and accuracy of detail(s).
• Provides information to open and close these “inquiries” as well as the updates to the information stated with initials and dates as appropriate.
• Works closely with Client Administration Coordinator to coordinate efforts of TPL “notices” externally. These include efforts for follow-ups internally with escalated unanswered Third-Party Liability Forms with Client Management.
• Receive and process Third Party Liability/Subrogation funds, allocation and appropriation. Close out Third-Party Liability case with appropriate notations/hard case file.
• Works to identify/review/action/pursue an appropriate Third-Party Liability/Subrogation concern/issue by opening a potentially recoverable inquiry.
• Maintains a high level of customer service in all aspects of the position.
• Screens calls. Makes all training meeting support copies/arrangements. Checks deadlines on incoming/outgoing inquiries & requests. Processes replies on own initiative or notes.
• Works to identify/review/action/pursue an appropriate Third-Party Liability/Subrogation concern/issue by opening a potentially recoverable inquiry.
• Close out Third-Party Liability case with appropriate notations/hard case file.
• Works to identify/review/action/pursue an appropriate Third-Party Liability/Subrogation concern/issue by opening a potentially recoverable inquiry.
• Close out Third-Party Liability case with appropriate notations/hard case file.

Requirements

• Excellent customer service and interpersonal skills, both in person and over the phone.
• Flexibility a must.
• Must be dependable and maintain excellent attendance.
• Familiarity with Subrogation Processes preferred but not required.
• Legal Experience a Plus.
• Ability to maintain confidentiality.
• Ability to work well with all levels of internal management and staff as well as outside clients and vendors.
• Strong computer and Internet research Skills.
• Ability to work independently with little or no supervision.
• Ability to grow with changing demands of the position and the company.
• Great writing skills, correspondence, and phone skills.
• Ability to multi-task efficiently.
• Highly proficient in ICD-10, CPT, and HCPCS codes.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.