The Senior Recovery / Resolutions Representative handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. The representative manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.
Extensive work experience, possibly in multiple functions.
Work does not usually require established procedures.
Acts as a resource for others.
Coordinates others' activities.
- High School Diploma / GED or higher
- 1+ years of customer service experience analyzing and solving customer problems
- Experience using computer to include using email tool for business communication
- Working Hours M - F 8:00 am - 4:30pm
- Experience working with subrogation
- Experience with negotiations
- Experience working in the healthcare industry
- 2+ years of claims or collections experience
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity