Overview
We are seeking a talented individual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement

The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources.

Responsibilities
You will work directly with our client’s membership, insurance adjusters, and attorney’s to:

Recovery Function – Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures
Comply and be knowledgeable of all federal and state laws governing the collection of accounts
Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to account
Negotiate payment arrangements within established guidelines
Investigative Function – Research claims as investigative support for the company to maximize profits of each account worked
Determine if a case has third party liability potential
Work collaboratively with internal and external contacts to determine account liability
Assign file to a Recovery Specialist after detailing investigation claims
Coordinate benefits with no fault and first party auto carriers
Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements
Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client
Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details
Investigative claims and accident details to identify recovery potential
Update internal systems with information obtained and actions taken on account
Ensure proper notification per client guidelines
Effectively work, maintain, and manage a variety of cases with current and accurate notes
Meet department objective standards for Customer Service.
Follow account process to ensure proper investigative steps are taken on each account
Follow client and state guidelines for determining potential for recovery on behalf clients
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
Qualifications
High School diploma or GED required
Minimum 6 months experience in health insurance industry, medical claims, data entry, or customer service required
Basic knowledge of Microsoft Word and Excel required
Basic computer proficiency required (typing, ability to navigate various websites)
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 when speaking over the phone or entering data
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
Basic knowledge of health insurance coverage and/or terminology preferred
Ability to organize information to be shared to parties as required
Ability to meet deadlines
Bilingual (Spanish & English) a plus
Base compensation ranges from $15.20 to $18.40. 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.

LI-KK1

Remote

junior

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Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Cotiviti values its diverse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)