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United States
Onsite
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Sr. Claim Recovery Specialist based in the United States.
The Senior Claim Recovery Specialist plays a vital role in identifying and pursuing reimbursement opportunities when healthcare benefit plans have paid medical expenses that may be the responsibility of another party. This position combines claims investigation, case management, negotiation, and stakeholder communication to help recover funds and support the financial sustainability of healthcare benefit plans. Working closely with attorneys, insurance adjusters, plan participants, employers, and claims administrators, the specialist evaluates potential recovery sources and coordinates the documentation needed to move cases forward. The role requires sound judgment, attention to detail, and the ability to manage a high-volume caseload while meeting strict deadlines. The successful candidate will contribute to accurate, compliant, and efficient recovery operations in a fast-paced environment. This is an opportunity for an experienced claims professional to apply their subrogation and reimbursement expertise while supporting more affordable healthcare benefits for employees and their families.
Claims Recovery & Case Management: Manage recovery files from initial review through resolution, identifying opportunities to recover medical expenses from appropriate third parties.
Recovery Investigation: Communicate with attorneys, insurance adjusters, and plan participants to identify potential sources of reimbursement, including automobile insurance, workers’ compensation, and first-party or third-party coverage.
Insurance Carrier Coordination: Contact insurance carriers to obtain claim details, including claim numbers, adjuster information, telephone numbers, fax numbers, and mailing addresses.
Negotiation & Follow-Up: Contact attorneys and adjusters to obtain case updates, negotiate recovery matters, and support timely resolution of outstanding claims.
Legal Research & Case Law: Develop familiarity with relevant case law and use available subrogation and reimbursement resources to support informed recovery decisions.
Client Communication: Communicate with health benefit plan sponsors, employers, and claims administrators by telephone and email, providing accident details, responding to inquiries, and addressing reduction requests.
Plan Document Review: Review health benefit plan documents to identify applicable exclusions and determine potential recovery rights and reimbursement obligations.
Correspondence & Documentation: Draft, prepare, mail, and fax correspondence and other case-related documents, ensuring accuracy, consistency, and timely completion.
Caseload Management: Maintain and prioritize a substantial caseload while tracking deadlines, following up on outstanding matters, and ensuring files are handled efficiently.
Administrative Support: Monitor voicemail messages and emails when providing out-of-office coverage for colleagues, and assist with day-to-day departmental activities as needed.
Systems & Reporting: Use Microsoft Word, Excel, Outlook, and other relevant applications to prepare correspondence, organize case information, and maintain accurate records.
Confidentiality & Compliance: Protect sensitive information, maintain confidentiality, and follow applicable requirements, including the Health Insurance Portability and Accountability Act (HIPAA).
Education: Associate degree or higher preferred.
Relevant Experience: One to three years of experience in subrogation, claims recovery, reimbursement, or a related field.
Claims Recovery Knowledge: Understanding of recovery opportunities, reimbursement processes, insurance coverage, and the identification of responsible payers.
Decision-Making Skills: Ability to assess recovery potential, determine appropriate reimbursement approaches, and make sound decisions based on available evidence and plan provisions.
Negotiation & Communication: Strong verbal and written communication skills, with the ability to communicate professionally with attorneys, adjusters, plan participants, and clients.
Research & Analytical Skills: Ability to define problems, collect and evaluate information, establish facts, interpret relevant case law, and draw valid conclusions.
Organization & Time Management: Demonstrated ability to manage a large caseload, prioritize competing tasks, meet deadlines, and maintain accuracy on time-sensitive documents.
Technical Proficiency: Familiarity with Microsoft Word, Excel, Outlook, and standard office equipment and document-processing tools.
Confidentiality & Compliance: Commitment to protecting sensitive health and claims information and complying with HIPAA requirements.
Language Skills: Ability to read, write, and speak English. Bilingual proficiency is preferred but not required.
Additional Qualifications: A paralegal certificate is preferred but not required.
Assessment Requirements: Must successfully pass applicable departmental assessments, including qualification tests administered by the department manager.
Work Environment: Ability to work effectively in a fast-paced office environment involving extended periods at a workstation, extensive computer use, and regular operation of office equipment.
Competitive Base Salary: Annual salary range of $50,000–$65,000, depending on qualifications and experience.
Employee Benefits: Access to an employee benefits package designed to support individual and family well-being.
Inclusive Workplace Culture: An environment that emphasizes empathy, collaboration, enjoyment, and respect.
Recognized Workplace: Opportunity to join an organization recognized by regional and national workplace awards for its employee culture.
Meaningful Impact: Contribute to recovering healthcare costs and supporting the affordability of health benefits for employees and their families.
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