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Subrogation Caseworker I
Ref No.: 16-00598
Location: Irving, Texas
Position Type:Contract
Start Date: 02/25/2016
Job Family: Operations
Job Title: Subrogation Caseworker I
Job Summary: Responsible for processing all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, management, settlement and related functions to the case.
Main Duties and Responsibilities:
  • Effectively work, maintain and manage a variety of cases with current and accurate notes from creation to recovery
  • Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.
  • Confirm documentation of eligibility for beneficiaries.
  • Conduct all case document review and updates as needed.
  • Confirm and validate third party liability and, probate and beneficiary asset research.
  • Interact professionally (i.e. on incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
  • Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
  • Negotiate and compromise claim/lien settlement amounts per contract guidelines.
  • Process all claim/lien disputes and review claims with attorneys and other stakeholders.
  • Conduct outgoing periodic follow up on case status and payment.
  • Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
  • Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting.
  • Compile, analyze and make conclusions about case information and status from multiple sources.
  • Meet department objective standards for Customer Service.
  • Complete periodic reports for management when necessary.
  • Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).
  • May have some training responsibilities limited to projects and specific tasks
Additional Essential Functions:
  • Ability to interact with all levels of people both internally and externally in a professional manner.
  • Ability to communicate and comprehend well both verbally and in writing, fluently in English.
  • Ability to be careful and thorough about detail including with cite-checking and proofreading skills.
  • Ability to multi-task and prioritize effectively.
  • Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required.
  • Ability to work independently to meet objectives.
  • Ability to analyze information and use logic to address work-related issues and problems.
  • Ability to perform oral presentations with good quality.
  • Ability to perform well in team environment, to achieve business goals.
  • Ability to maintain a high level of confidentiality and ethics.
  • Ability to function effectively under pressure and manage deadline oriented project demands and multiple initiatives.
  • Ability to sit for long periods of time.
  • Ability to perform the following: lifting, bending, pushing, pulling, stopping, kneeling, reaching, and carrying of light to heavy items (40 to 50lbs).
  • Average manual dexterity work in use of a PC, phone, sorting, filing and other office machines.
Minimum Education: High School Diploma or GED required
Associates degree preferred
Certifications: (Required/Desired) Paralegal certificate desired
Minimum Related Work Experience: 2+ years' of relevant experience
Experience managing large case loads required
Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) a plus
Knowledge of Microsoft Word and Excelrequired.
Basic knowledge of Microsoft Access preferred.
Medicaid and/or Medicare knowledge preferred.
Bilingual (Spanish & English) a plus.