Key Facts

Remote From:

Full time

English

Hard Skills

Pharmacy Law Subrogation Medical Record Management File Management Data Entry Priority Queue Escalation Procedures Case Assessment Investigative Interviewing Applied Research Stakeholder Engagement Clinical Documentation Recruitment Software Client Education Online Communication Employee Coaching

Other Skills

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Microsoft Excel
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Report Writing
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Virtual Teams
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Word Processing
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Computer Literacy
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Non-Verbal Communication
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Time Management
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Teamwork
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Critical Thinking
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Detail Oriented
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Social Skills
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Problem Solving

Roles & Responsibilities

Two years equivalent professional experience in medical insurance, or other investigation processes
Demonstrated intermediate computer literacy, including word processing and spreadsheet experience
Demonstrated ability to handle the complexities of the case-file investigation process with the ability to analyze, evaluate, prepare, and organize cases while prioritizing tasks and manage caseload
Demonstrated critical thinking skills with the ability to analyze and then provide recommendations for problem resolution

Requirements:

Research, investigate, and validate potential subrogation cases through prioritization of incoming communications, questionnaires, and case referrals, and participate in case preparation and documentation
Organize incoming information on potential subrogation cases by reviewing claims history, medical records, and other relevant information to support determination of viable subrogation cases; escalate for further investigation when necessary
Analyze all incoming information to determine possible subrogation recovery and viability of various actions for each case; catalog and enter information from communications, questionnaires, and COB forms into the subrogation database while ensuring data accuracy
Educate members and internal customers on the subrogation process; assist in training internal staff and act as a resource for internal partners

Mount Saint Vincent

About Mount Saint Vincent

Mount Saint Vincent’s mission is as relevant today as it was 141 years ago—to partner with children and families to heal beyond trauma into a healthy and hopeful future. We support children and families with pediatric services across this continuum of care:Pediatric Behavioral Health TherapiesOur therapists are trained in evidenced-based modalities including, but not limited to play therapy, trauma therapy, cognitive behavioral therapy, Parent-Child Interaction Therapy, dialectical behavior therapy, family systems, eye movement desensitization and reprocessing, and the Neurosequential Model of Therapeutics. Below are summaries of our core therapies utilizing these modalities:• Outpatient Therapy (ages 2-18 years) - Individual, family and group therapies—in office or through telehealth—to accommodate behavioral and mental concerns beyond those caused by trauma, abuse and neglect.• In-Home Therapy (ages 2-12 years) - Intensive trauma-informed therapies to support families with children living in their homes experiencing behavioral, emotional and mental health concerns.• Day Treatment and Education (ages 5-13 years) - Enrolling students struggling in traditional school settings, this program features a therapeutic milieu to successfully reintegrate them to their schools of origin.Foster Care Program (ages newborn to 18 years)To help navigate the process of becoming a foster parent, our program offers traditional and therapeutic training, certification and individualized support. Foster parents provide temporary 24-hour care to children who cannot remain in their homes of origin due to abuse, neglect or other safety concerns. Preschool (ages 3-5 years)Earning five out of five stars from Colorado Shines, the high-quality rating program for preschools, our early learning center encourages exploration, creativity and growth in all aspects of child development. Our program offers full, half and extended-day options.

Founded: 2018

Company size: 51 - 200

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Job description

Job Description:

This position performs research, investigates, and then validates potential subrogation cases through the prioritization of incoming communications, questionnaires, and case referrals, and then participates in case preparation and documentation. Supports the investigatory process within escalated cases, while educating members and internal customers on the subrogation process.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington.

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings

Schedule:

Monday-Friday 8:00am-4:00pm

Job Details:

Organizes incoming information on potential subrogation cases. This includes reviewing claims history, medical records, and any other relevant information in order to support the determination of viable subrogation cases. If further investigation is necessary, escalates the case for investigation. This requires them to have a broad range of knowledge of the various aspects of subrogation and related functions.
Analyzes all incoming information to determine possible subrogation recovery, while exploring and determining the viability of various actions for each individual case. This includes cataloging and entering information from all incoming communications, questionnaires, and paperless coverage of benefits (COB) forms into subrogation database while ensuring accuracy and up to date data management on subrogation cases.
Assists in training internal staff on subrogation procedures and courses of action. Educates members on the subrogation process. Acts as a resource for internal partners.
Supports subrogation ACD line, which includes calls from the Health Benefits Specialist customer support, attorney's offices, members, and others when necessary.
Participates in team meetings and trainings including offsite meetings and trainings when deemed appropriate.
Investigates cases of mild to moderate complexities, including assisting with interviews as part of an investigation.

Minimum Qualifications:

Two years equivalent professional experience in medical insurance, or other investigation processes.
- and -
Demonstrated intermediate computer literacy, including word processing and spreadsheet experience.
- and –
Demonstrated ability to handle the complexities of the case-file investigation process with the ability to analyze, evaluate, prepare, and organize cases while prioritizing tasks and manage caseload
- and -
Demonstrated critical thinking skills with the ability to analyze and then provide recommendations for problem resolution.
- and -
Excellent oral and written communication skills and ability to interact effectively with all levels of internal personnel, as well as providers, members, attorneys, and any other involved parties.
- and -
Ability to work effectively in a team environment or independently as required.

Preferred Qualifications:

Associate degree in related field such as business. Education must be obtained through an accredited institution. Degree will be verified.
SelectHealth experience with basic internal knowledge of medical and/or pharmacy claims, payment policies and terminology.

SH only

Interact with others requiring the employee to communicate information.
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Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$22.64 - $34.48

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

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