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Years of Experience
Date Last Verified
ProfileClient Legal Support - Subrogation Case Worker II The candidate will be responsible for processing all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. Will intake, maintenance, claims review and selection, management, settlement and related functions to the case. 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.
Qualification and Experience
The candidate should have high School Diploma or GED. Paralegal certificate is desired. Associates degree is preferred; Education in Legal Studies preferred; Bachelors in legal studies is desired. Must have 3+ years’ relevant experience. OR 1+ year of HMS experience and 2+ years of relevant experience . Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) is a plus. Knowledge of Microsoft Word and Excel is required. Basic knowledge of Microsoft Access is preferred. Medicaid and/or Medicare knowledge is preferred. Bilingual (Spanish and English)is a plus.