Casualty Case Management Specialist - Remote US

Summary

We are seeking a Casualty Case Management Specialist to manage all casualty and estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries. This role is responsible for the intake, maintenance, claims review, case management, settlement, and all related activities within the assigned caseload.

Your role in our mission

• Ensure all processes meet HIPAA and government security requirements regarding the sharing and storage of Personal Health Information (PHI).
• Utilize strong analytical and case management skills to oversee 700–1,000 subrogation cases simultaneously.
• Communicate professionally—primarily via inbound and outbound calls—with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients.
• Prepare and manage required correspondence, liens, claims, and related documentation throughout the recovery process.
• Meet departmental goals for customer service, settlements, and case handling standards.
• Perform both basic and advanced document and legal reviews to determine case status, ensure accuracy, and support workflow progression.
• Verify beneficiary eligibility and maintain accurate documentation.
• Confirm and validate third-party liability, probate, and asset research findings.
• Compile and analyze information from multiple sources to determine case status and recovery potential.
• Process and resolve claim or lien disputes; collaborate with attorneys and relevant stakeholders as needed.
• Conduct periodic follow-ups on case status, payments, and settlement updates.
• Negotiate and finalize claim or lien settlement amounts according to established contract guidelines.
• Execute and file notarized documents with applicable county offices.
• Prioritize case events, payment issues, and revenue-impacting deadlines to ensure timely resolution.
• Maintain accuracy, timeliness, and productivity standards for file management and phone metrics.

What we're looking for

• 2+ years of relevant professional experience in subrogation, claims, or case management.
• Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
• Experience in a legal or insurance office setting (paralegal, legal assistant, casualty, or health insurance experience preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred.

What you should expect in this role

• Work Location: Remote – Anywhere within the United States.
• Technology Requirements:
  • A broadband internet connection with minimum speeds of 24 Mbps download and 8 Mbps upload is required (higher speeds recommended).
  • Video cameras must be used during all interviews and the initial week of orientation.
  • To test your internet speed, go to Google and search for “Internet Speed Test.”

Employee Benefits & Perks:

• Health benefits (medical, dental, and vision) begin on Day 1 of employment.
• 401(k) with company match and additional benefits become available within the first few months.
• Employees can take advantage of the flexible vacation policy after 90 days of employment. Any exceptions require manager approval before the employee's start date at Gainwell.
• Career growth and advancement opportunities are encouraged and supported.
• A company-provided computer is supplied for work use.