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Associate Claims Examiner/ Senior Case Worker- Hybrid Englewood, CO

Date:  Jun 18, 2022

Any city, WY, US, 99999

Req ID:  8918


We are seeking a talented individual for a Associate Claims Examiner who is responsible for processing all probate and estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries.  This includes intake, maintenance, claims review and selection, asset investigation, court filings and deadline management, settlement and other related functions to the case.

Job Description

Essential Job Functions

  • Effectively 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.
  • Daily telephone contact with counterparties, including attorneys, adjusters and family members
  • Confirm documentation of eligibility for beneficiaries.  
  • Conduct all case document review and updates as needed.
  • Confirm and validate third party liability and, probate and 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 serve as an escalation point for project team
  • May have some training responsibilities limited to projects and specific tasks

Basic Qualifications

  • 5+ years’ relevant experience. OR 3 year of Gainwell Technologies experience and 2+ years of relevant experience 
  • Experience in a Legal office or environment a plus; paralegal or legal assistant and/or experience in state government or the insurance industry (casualty or health insurance/Medicaid) a plus
  • Knowledge of Microsoft Word and Excel required.
  • Basic knowledge of Microsoft Access preferred.
  • Medicaid and/or Medicare knowledge preferred.
  • Bilingual (Spanish & English) a plus.

Other Qualifications

  • Ability to interact with all levels of people both internally and externally in a professional manner.
  • Ability to be careful and thorough about detail including with cite-checking and proof-reading skills.  
  • Ability to read real estate documents i.e. deeds, assessor records
  • Ability to read and interpret legal documents
  • 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 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 handle pressure and manage deadline oriented project demands and legal deadlines

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