COB and Subrogation Specialist (Health Insurance)

TL;DR

COB and Subrogation Specialist (Health Insurance): Managing medical cost recoveries from third-party liabilities and other health plans with an accent on negotiation, compliance with CMS/DPW/PID regulations, and case prioritization. Focus on maximizing recoveries through effective claim identification, settlement negotiations, and process optimization.

Location: Remote (Must be based in the USA)

Salary: $46,125 - $61,500 annually

Company

hirify.global creates innovative health benefit solutions and services for small and midsize businesses and their employees.

What you will do

• Triage, prioritize, and track notifications of third-party liability for medical costs incurred by members.
• Maintain detailed records of open subrogation cases and ensure adherence to timeliness requirements.
• Lead the negotiation and final settlement of subrogation claims to maximize cost recovery.
• Identify and implement process improvements to increase collections in subrogation and COB overpayments.
• Collaborate with payment integrity leadership on provider credit balance recoupments and other projects.
• Partner cross-divisionally to ensure technology and processes support optimal departmental workflows.

Requirements

• Experience with subrogation processes within a commercial health plan.
• Ability to interpret and apply complex CMS, DPW, and PID regulations regarding coordination of benefits and subrogation.
• Strong organizational, interpersonal, and communication skills.
• High level of attention to detail and ability to manage multiple priorities simultaneously.
• Work authorization and residency in the United States (indicated by 401k and US regulatory requirements).

Nice to have

• Previous startup company experience.

Culture & Benefits

• Comprehensive rewards package including alternative medicine coverage.
• Generous PTO and up to 16 weeks of paid parental leave.
• 401k program and education reimbursement.
• Unique perks such as transportation benefits and paid paw-ternity leave.
• Non-hierarchical, merit-driven culture in a high-performance, fast-paced environment.