Description The Subrogation Professional 2 iIdentifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health insurance. The Subrogation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities Responsible for investigating and recovering paid benefits as a result of other party responsibility due to Third Party Liability (Subrogation) and Workers' Compensation; Investigates by way of inbound and outbound phone calls, letters and faxes to gather facts to support recoverable opportunities; Maintains case files and responds to various inquiries from first and third party participants, including lawyers, other insurance professionals, etc.; Interprets plan language and state & federal case law to determine applicability to case; Performs analysis of claims to ensure accuracy of payment and relatedness to recoverable opportunity; Negotiates settlement of subrogation claims with first & third party participants, including attorneys and other insurance professionals Handles a caseload of greater than 450 subrogation and/or workers' comp files Investigates by way of inbound and outbound phone calls, letters and faxes to gather facts to support recoverable opportunities Performs analysis of claims to ensure accuracy of payment and lien opportunity Analyze liability, causation and damages Ability to interpret and apply state and federal legislation and case law to applicable case Negotiate effective settlements with a variety of first and third party participants, including lawyers, other insurance professionals, etc. Partner with Humana attorneys when applicable Required Qualifications Strong written and verbal communication skills Strong Microsoft Office proficiency — ability to create forms, reports, and documents in Word and Excel Property and causality experience, criminal justice or investigative/analyst experience Extensive customer service experience, especially in an in-bound phone environment Strong organizational abilities Ability to manage multiple time sensitive tasks Excellent ability to interact with associates at all levels of the organization Strong analytical and creative problem-solving skills Associate or Bachelor's degree typically requires Bachelor's degree or equivalent and less than 5 years of technical experience Preferred Qualifications Master's Degree in Business or related field Previous Subrogation experience Additional Information Scheduled Weekly Hours 40 SDL2017
