Subrogation Specialist I

This is a Remote Full-time opportunity.

 
This position requires the Subrogation Specialist to process a paperless health insurance subrogation caseload by investigating potential cases and pursuing med-pay, no-fault, liability, and workers’ compensation recoveries.

Responsibilities include investigating new potentials cases, placing outbound calls as well as submitting correspondence to health plan members, insurance companies, and attorney offices. The Subrogation Specialist coordinates efforts with other members of the subrogation team to maximize recovery in accordance with EXL’s Subrogation Policies and Procedures.

Complying with HIPAA regulations as well as EXL’s HIPAA and Information Security policies and procedures, including required training and incident reporting.

KEY RESPONSIBILITIES & JOB FUNCTION:

• Learn and understand fundamentals of health insurance subrogation, including basic health plan contractual provisions that apply to the reimbursement efforts.
• Review, Identify and develop subrogation opportunities by gathering missing information and potential sources of recovery.
• Place parties of interest on notice.
• Organize and structure investigations to work in priority order using the tools provided.
• Respond timely to all electronic, written, and verbal communications.
• Log and maintain detailed and accurate records.
• Access and pull benefits from clients’ health claim systems.
• Pursuing worker’s compensation, third party liability, first party uninsured and underinsured recovery, worker’s compensation, med-pay coverage, and no-fault recoveries.
• Engage advice and/or help of legal manager to proactively resolve cases.
• Ensure compliance with state and federal laws.
• Adhere to settlement authority levels.
• Maintain department productivity and quality standards.
• Sensitivity to privacy in accordance with HIPAA guidelines

Minimum Requirements

• Proficiency with Microsoft Word, Excel, and internet research
• High School or equivalent education level

Preferred Requirements

1+ years’ experience with any or all the below.

• Subrogation experience
• Claims experience.
• Supporting heavy call volume  

Professional Skills

• Developed customer service skills.
• Strong organizational and time management skills
• Ability to work independently and as part of a team.