Subrogation Specialist - Remote in VA

Sentara Health

3d•Remote

About The Position

Protects and enforces reimbursement/subrogation rights of Sentara to recover funds from responsible parties. Identifies possible third-party responsibilities and initiates appropriate action to recover funds paid for various expenses and additional costs. Maintains security and confidentiality of provider health information and medical records. Reviews medical and pharmacy claims to determine which paid claims are directly related to the accident/injury and should be included in the lien for reimbursement. Negotiates settlement of liens and coordinates payment to the company. Finalizes the recovery and release of lien and interacts with legal counsel. Research, analyze, and interpret member contract language, state and federal law as it applies to submitted claims subject to reimbursement. Apply contract provisions and statutes to gather factual circumstances to determine individual cases where possibilities for subrogation and recovery. Assembles relevant file information about members, injury, paid claims, potential third-party liability, and attorney representation. Conducts critical data analysis associated with data mining, Service Forms, Coordination of Benefits and Subpoenas to maximize recoveries. Serves as the key point of contact for receipt, response and/or appropriate distribution of Subrogation Service Forms and independent individual referrals to the department. Develops and maintains subrogation files and assembles member information, claims paid, potential third-party wrongdoer, and third-party claims data. Identifies members who have a duty to reimburse the company for paid medical or pharmaceutical claims, to include communication and correspondence with members, attorneys, and other involved parties on a routine basis.

Requirements

Associate's Degree
3 years relevant work experience in subrogation claims or other adjuster/claims REQUIRED
Strong Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, etc.)

Nice To Haves

Prior paralegal or healthcare experience preferred
Working knowledge of Virginia law preferred

Responsibilities

Protects and enforces reimbursement/subrogation rights of Sentara to recover funds from responsible parties.
Identifies possible third-party responsibilities and initiates appropriate action to recover funds paid for various expenses and additional costs.
Maintains security and confidentiality of provider health information and medical records.
Reviews medical and pharmacy claims to determine which paid claims are directly related to the accident/injury and should be included in the lien for reimbursement.
Negotiates settlement of liens and coordinates payment to the company.
Finalizes the recovery and release of lien and interacts with legal counsel.
Research, analyze, and interpret member contract language, state and federal law as it applies to submitted claims subject to reimbursement.
Apply contract provisions and statutes to gather factual circumstances to determine individual cases where possibilities for subrogation and recovery.
Assembles relevant file information about members, injury, paid claims, potential third-party liability, and attorney representation.
Conducts critical data analysis associated with data mining, Service Forms, Coordination of Benefits and Subpoenas to maximize recoveries.
Serves as the key point of contact for receipt, response and/or appropriate distribution of Subrogation Service Forms and independent individual referrals to the department.
Develops and maintains subrogation files and assembles member information, claims paid, potential third-party wrongdoer, and third-party claims data.
Identifies members who have a duty to reimburse the company for paid medical or pharmaceutical claims, to include communication and correspondence with members, attorneys, and other involved parties on a routine basis.

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.