Medicaid Sr. Caseworker (Hybrid - Raleigh, NC)

Summary

HMS works to make the healthcare system better for everyone. We identify and prevent fraud, waste, and abuse so individuals can access the care they need—now and in the future. Through innovative technology and powerful data analytics, we help government and commercial payers reduce costs, improve quality, and meet regulatory requirements. We also empower consumers to take a more active role in their health. Each year, we save our clients billions of dollars while supporting healthier communities.
At HMS, you will have the opportunity to develop new skills, grow your career in a dynamic industry, and make a meaningful difference in the lives of others.
We are seeking a detail-oriented and motivated Case Management Assistant (Onsite). This role is responsible for verifying, documenting, and coordinating information required to process applications and case management assignments. Responsibilities include confirming third-party liability, validating documentation, coordinating with employers, and providing high-quality customer service while ensuring accurate data entry, timely processing, and compliance with program requirements.

Your role in our mission

• Verify, document, and investigate healthcare coverage and claims related to Medicaid Estate Recovery cases to ensure accurate case processing and regulatory compliance.
• Manage a high-volume caseload of 30 to 40 cases per day, consistently achieving 98% accuracy and compliance while meeting productivity standards.
• Conduct outbound follow-up calls regarding case status, payment information, recovery efforts, and outstanding documentation requirements.
• Prioritize and coordinate case activities, including critical payment and estate recovery functions, while meeting all internal, client, and regulatory deadlines.
• Maintain detailed and accurate case documentation in accordance with company policies, client requirements, and applicable state and federal regulations.
• Prepare and complete recurring and ad hoc reports to support operational goals, compliance monitoring, and client reporting needs.
• Provide training, mentoring, and ongoing support to new and existing team members, serving as a subject matter expert on Medicaid Estate Recovery processes, policies, and systems.
• Assist with onboarding, knowledge transfer, and cross-training initiatives to strengthen team performance and operational consistency.
• Support team success by resolving escalated issues, answering process-related questions, and collaborating with leadership to identify and implement process improvements.
• Communicate professionally and effectively with attorneys, insurance adjusters, healthcare providers, court personnel, estate representatives, recipients, family members, internal clients, and other stakeholders to facilitate timely case resolution and recovery outcomes.
• Consistently maintain high-quality service standards while balancing productivity, accuracy, and compliance requirements in a fast-paced environment.

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 (Estate recovery or casualty preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred

What you should expect in this role

•    Hybrid work arrangement based in the Raleigh, Norrth Carolina office — onsite 2 days per week.
•    Schedule: Monday–Friday, 8:00 AM – 5:00 PM.
•    Video cameras are required during all interviews and throughout the first week of orientation.
•    To work effectively as a teleworker or hybrid employee, you must have broadband internet with a minimum speed of 24 Mbps download and 8 Mbps upload (higher speeds recommended for optimal performance).

This posting is intended for pipelining. We will accept applications on an ongoing basis.

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