The Subrogation Recovery Specialist is responsible for analyzing and recovering dollars related to an accident, injury, or illness in which another party is responsible. The Subrogation Recovery Specialist must work with attorneys, other health carriers, adjustors and more to both accelerate and maximize settlement amounts which will lead to savings for our clients. This position requires a combination of both oral and written communication skills combined with the ability to proficiently review healthcare claims and case documentation to deliver value and maintain a high standard of quality.

• Effectively work, 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.
• Confirm documentation of eligibility for beneficiaries.
• Conduct all case document review and updates as needed.
• Confirm and validate third party liability and, probate and beneficiary 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
• 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.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

• High School Diploma or GED required. Bachelor's degree preferred
• 3+ years relevant experience
• Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance)
• Internal promotional opportunities for Investigation Specialist or employees with 1 year of Cotiviti experience
• Proficiency in Microsoft Excel and Word required
• Basic computer proficiency required (typing, ability to navigate various websites)
• Ability to analyze information and use logic to address work-related issues, problems, or opportunities
• Ability to perform presentations with good quality
• 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 in all aspects of the role
• Ability to interact with all levels of people both internally and externally in a professional manner
• Working knowledge of HIPAA privacy and security rules
• Ability to maintain a high level of confidentiality and ethics
• Working knowledge of Subrogation industry required
• Ability to interpret an Explanation of Benefits (EOB), UB-04, Form 5500, Summary Plan Description (SPD), Master Plan Document (MPD), Evidence of Coverage (EOC) preferred.
• Medicaid and/or Medicare knowledge preferred
• Ability to organize information to be shared to parties as required
• Ability to handle pressure and manage deadline-oriented project demands and multitask on caseload
• 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.
• Problem-Solving: Subrogation professionals must be able to analyze complex cases, identify liable parties, and determine the best strategies to recover funds.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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.
• No adverse environmental conditions expected.

Base compensation ranges from $19.00 per hour to $21.00 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.

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: 6/11/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 6/16/2025, 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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