What are the responsibilities and job description for the Subrogation Specialist position at Umpqua Health Management LLC?
The Role:
The Third-Party Recovery Specialist will be responsible for managing third-party claims related to services and community programs. This role focuses on pursuing subrogation opportunities to recover costs from third parties (e.g., insurance companies, liable individuals, or organizations) for medical services provided to patients. The ideal candidate will have expertise in healthcare insurance, subrogation processes, and a strong understanding of community health initiatives, working to ensure that recovery efforts are efficient, timely, and compliant with healthcare regulations.
Your Impact:
- Investigate and process third-party claims, identifying subrogation opportunities for recovery of healthcare-related expenses incurred by patients due to another party’s liability.
- Work closely with insurance companies, healthcare providers, legal teams, and community organizations to initiate subrogation actions and manage claims effectively.
- Collect and analyze relevant patient, insurance, and medical records to build subrogation cases, ensuring all documentation is accurate and compliant with healthcare regulations.
- Coordinate with legal teams and third-party insurers to pursue and negotiate subrogation settlements, aiming for the recovery of costs related to healthcare services and community-based programs.
- Monitor and track the status of subrogation cases, ensuring timely follow-up and resolution of claims, while keeping detailed records of all recovery efforts.
- Ensure all subrogation efforts adhere to healthcare regulations and guidelines, such as HIPAA, and follow state and federal subrogation laws.
- Provide regular updates and reports on the status of subrogation cases, identify recovery trends, and suggest improvements to enhance recovery efficiency and accuracy.
Your Credentials:
- High school diploma required; Bachelor’s degree in Healthcare Administration, Insurance, or related field preferred.
- 2-3 years in subrogation, insurance claims, or third-party claims management, preferably in healthcare or community health.
- Knowledge of healthcare insurance, subrogation processes, and regulatory compliance; strong communication and negotiation skills.
- Certification in Insurance (AINS, CPCU) or related certifications in healthcare subrogation preferred.
