- Time Management
- Analysis Skills
- Microsoft Office
- Paralegal Certificate
- Health Insurance
- Work From Home
This is a remotely located role- 100% work from home/home office opportunity.
Discovery Health Partners offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience. We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results.
The Senior Recovery Analyst is accountable for managing the coordination of claim payments among health plans and other responsible parties through negotiations for a successful recovery of 1st and 3rd party funds. The candidate must be confident on the phone and comfortable interacting and negotiating with attorneys and other interested parties. Responsibilities include managing a “paperless” healthcare subrogation case load through investigation, pending and settlement stages of the recovery process. The Discovery Health Partners work environment is team oriented; the Senior Recovery Analyst is expected to coordinate efforts with all parties to bring matters to efficient and successful outcome. The employee must be extremely detail oriented and effective in managing the subrogation recovery process.
Candidates should have experience in the health insurance/personal injury fields and proven experience with managing a mixed case load including workers compensation, third party liability, medical payment, personal injury protection, under insured motorist/uninsured motorist and no-fault coverages. The position includes a training program that teaches the employee about the healthcare subrogation process. Prior subrogation and negotiation experience is required.
KEY RESPONSIBILITIES & JOB FUNCTION:
Identify and develop complex subrogation recovery/settlement opportunities following client specific policies, procedures and guidelines and negotiate settlements in the best interest of those clients and Discovery Health Partners.
Continuously research and request case information or status to drive cases to resolution.
Maintain detailed and accurate case records and calendar diaries to monitor case activities to meet department expectations.
Respond timely to all electronic, written and verbal communications within a defined deadline
Access and retrieve benefit detail from clients’ remote health claim systems
Collaborate with the legal team and management to proactively resolve cases
Ensure compliance of all state and federal laws
Maintain department recovery, productivity and quality standards
Act as a mentor for newly hired Recovery Analyst and/or other new hires to the department
Participation in department-wide training initiatives/education
Provide feedback to management on trends or developments
Comply with HIPAA regulations as well as Discovery’s HIPAA and Information Security policies and procedures, including required training and incident reporting.
Proven negotiation experience, specifically in the capacity of persuading and influencing others; ability to negotiate fair settlement consistent with the prevailing subrogation law
Effective and exceptional communication skills
Strong organizational and time management skills with the ability to multi-task and work independently
Strong analytical, problem solving and decision-making skills; ability to exercise good judgment
Understand basic health plan contractual provisions and apply to reimbursement efforts
Paralegal Certificate (Preferred)
Associate degree, preferably legal studies or paralegal studies
2+ years experience in health, disability or P&C insurance
Working knowledge of Microsoft Office and internet research skills
Discovery Health Partners provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics