at MultiPlan in Naperville, Illinois, United States
Job Description
Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.
Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!
This role is accountable for developing cases after the initial investigation to confirm viability of subrogation cases. Moreover, the incumbent manages the coordination of claim payments among health plans, collects refunds of duplicate payments from providers, and successful recovery of 1st party funds. The role provides a final determination on all potential sources of recovery and fully prepares the cases for the Paralegals to successfully negotiate the liability claims. This role requires the incumbent be confident on the phone and comfortable interacting with insurance companies, providers, health plan members, and personal injury attorneys.
JOB ROLES AND RESPONSIBILITIES:
1. Review, identify, and develop subrogation opportunities by gathering missing information and potential sources of recovery. Research and analyze information gathered through continuous investigation. Record and maintain detailed and accurate records.
2. Validate claim viability and terminate pursuit when necessary; respond timely to all electronic, written and verbal communications.
3. Place parties of interest on notice and send subsequent demand letters.
4. Continuously research and make outbound calls to request case information or status to drive cases to be prepared for settlement; maintain detailed and accurate case records and calendar diaries to monitor case activities to meet department expectations.
5. Engage advice and/or help of Negotiators/Paralegals to proactively resolve and/or transfer cases.
6. Ensure compliance of state and federal laws and maintain department productivity and quality standards.
7. Take transferred calls and/or documents from inbound investigation teams to provide a resolution to the enquiry.
8. Collaborate, coordinate, and communicate across disciplines and departments.
9. Ensure compliance with HIPAA regulations and requirements.
10. Demonstrate Company's Core Competencies and values held within.
11. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
12. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
This role keeps the needs of external and internal customers as a priority when making decisions and taking action. The successful incumbent operates independently under limited supervision. This role tasks the incumbent with decision making authority within specified parameters and must engage to obtain advice and/or help of legal manager, negotiator, or paralegal to proactively resolve cases. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Â Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
