Subrogation Investigation Specialist

Overview

The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources. We are seeking a talented individual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement.

Responsibilities

• You will work directly with our client’s membership, insurance adjusters, and attorneys to:
• Recovery Function – Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures:
  • Comply and be knowledgeable of all federal and state laws governing the collection of accounts.
  • Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to the account.
  • Negotiate payment arrangements within established guidelines.
• Investigative Function - Research claims as investigative support for the company to maximize profits of each account worked:
  • Determine if a case has third-party liability potential.
  • Work collaboratively with internal and external contacts to determine account liability.
  • Assign file to a Recovery Specialist after detailing investigation claims.
  • Coordinate benefits with no fault and first party auto carriers.
• Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements.
• Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client.
• Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details.
• Investigative claims and accident details to identify recovery potential.
• Update internal systems with information obtained and actions taken on account.
• Ensure proper notification per client guidelines.
• Effectively work, maintain, and manage a variety of cases with current and accurate notes.
• Meet department objective standards for Customer Service.
• Follow account process to ensure proper investigative steps are taken on each account.
• Follow client and state guidelines for determining potential for recovery on behalf clients.
• Develop templates for system training materials based on the training strategy.
• Deliver specific application training based on use needs analysis.
• Create and document training materials based on key functionality across the application.
• Coordinate with product teams to keep training materials current with updated functionality and features.
• Develop additional system support materials such as user job aids.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

• High School diploma or GED required.
• Minimum 1-2 years of experience in the health insurance industry, medical claims, data entry, or customer service required.
• Basic knowledge of Microsoft Word and Excel required.
• Basic computer proficiency required (typing, ability to navigate various websites).
• Ability to work independently to meet objectives.
• Ability to perform well in a team environment.
• Strong verbal and written communication skills.
• Ability to be thorough and detailed when speaking over the phone or entering data.
• Ability to interact with all levels of people, both internally and externally, professionally.
• Working knowledge of HIPAA privacy and security rules.
• Ability to maintain a high level of confidentiality and ethics.
• Basic knowledge of health insurance coverage and/or terminology preferred.
• Ability to organize information to be shared with parties as required.
• Ability to meet deadlines.
• Bilingual (Spanish & English) a plus.
• Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Mental Requirements:

• Investigative Skills: They often need to sift through evidence, contracts, and claims to uncover the cause of loss and determine responsibility.
• Critical Thinking: It’s essential to question assumptions and consider multiple perspectives when evaluating the facts surrounding a claim.
• Accuracy in Documentation: Subrogation requires a high degree of precision in handling legal, financial, and case documents. Missing or incorrectly processed information can lead to significant delays or errors in recovery efforts.
• Understanding Legal Processes: Familiarity with the legal processes involved in subrogation is key. Subrogation professionals need to understand how laws, contracts, and liability work.
• Cost-Benefit Analysis: Subrogation specialists must evaluate whether pursuing a claim is financially worthwhile, considering legal costs, the likelihood of recovery, and the potential for financial return.
• Integrity and Ethics: Subrogation professionals must make ethical decisions, especially when handling sensitive financial data, client information, and during legal negotiations. They should adhere to legal guidelines and corporate policies while ensuring fair treatment of all parties involved.

Working Conditions and Physical Requirements:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• No adverse environmental conditions expected.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Base compensation ranges from $17.75 to $20.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 4/30/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/13/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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