Sentara Health Plan is currently hiring a Subrogation Specialist- Remote in VA!

Overview

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.

Education

• Associate's Degree

Experience

• 3 years relevant work experience in subrogation claims or other adjuster/claims REQUIRED

• Prior paralegal or healthcare experience preferred

• Working knowledge of Virginia law preferred

• Strong Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, etc.)

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com (Opens in a new tab) and use the following as your Keyword Search: JR-94456

Talroo-Health Plan

Keywords: Managed Care, MCO, Healthcare, Health Plan, Health Insurance, Remote, Virginia, Associate Degree, Subrogation, Claims, Paralegal, Medical records, reimbursement