Casualty Case Management Specialist - Remote US

Summary

We are seeking a talented individual for a Casualty Case Management Specialist who is responsible for processing all casualty or estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries.  This includes intake, maintenance, claims review and selection, management, settlement, and related functions to the case.

Your role in our mission

• Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information)  
• Utilize complex analytical skills to manage subrogation cases, notate files and negotiate settlements on 700 to 1,000 cases at a time
• Interact professionally, primarily using incoming and outgoing calls, with attorneys, insurance adjusters, medical providers, court staff, recipients and family members, and clients
• Prepare required correspondence, liens, claims, and other related documents to progress the case to recovery
• Meet department objective standards for Customer Service, settlement goals, and file handling guidelines
• Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
• Confirm documentation of eligibility for beneficiaries
• Conduct all case document review and updates as needed
• Confirm and validate third party liability, probate, and beneficiary asset research
• Compile, analyze, and make conclusions about case information and status from multiple sources 
• Process all claim/lien disputes and review claims with attorneys and other stakeholders
• Conduct outgoing periodic follow up on case status and payment
• Negotiate and compromise claim/lien settlement amounts per contract guidelines
• Sign and file notarized documents with counties on applicable cases
• Prioritize case events and critical case payment/recovery issues, while meeting various internal and legal deadlines that are revenue impacting
• Meet file handling and phone call metrics related to each case

What we're looking for

• Medicaid and/or Medicare knowledge preferred
• 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 proofreading skills  
• Ability to multitask and prioritize effectively  
• Knowledge of Microsoft Word and Excel required
• Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required     
• Basic knowledge of Microsoft Access preferred
• Ability to work independently to meet objectives
• Ability to analyze information and use logic to address work-related issues and problems
• 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 multiple initiatives
• Two years of relevant experience 
• Experience in a Legal office preferred; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) preferred

What you should expect in this role

Remote position

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