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Call Center Investigations Specialist
Naperville, IL
Job Description
Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.
Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!
This position will take a high volume of inbound calls to process a paperless health insurance subrogation caseload by investigating potential cases and pursuing med-pay, no-fault, liability, and workers' compensation recoveries. This position's work environment is team-orientated. The incumbent will coordinate efforts with other members of the subrogation team to maximize recoveries.
JOB ROLES AND RESPONSIBILITIES:
1. Follow client specific procedures and guidelines. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws.
2. Adapt to process changes and help improve and implement new processes.
3. Identify and develop subrogation opportunities.
4. Research and request case information to develop cases. Access and pull benefits from clients' remote health claim systems.
5. Place parties of interest on notice.
6. Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain detailed and accurate records. Maintain a calendar diary to monitor case activity.
7. Pursue worker's compensation, first and third party, med-pay coverage and no-fault recoveries.
8. Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
9. Maintain department productivity and quality standards.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
1. Follow client specific procedures and guidelines. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws.
2. Adapt to process changes and help improve and implement new processes.
3. Identify and develop subrogation opportunities.
4. Research and request case information to develop cases. Access and pull benefits from clients' remote health claim systems.
5. Place parties of interest on notice.
6. Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain detailed and accurate records. Maintain a calendar diary to monitor case activity.
7. Pursue worker's compensation, first and third party, med-pay coverage and no-fault recoveries.
8. Engage advice and/or help of Management to proactively resolve cases. Provide feedback to Management and unit on trends or developments.
9. Maintain department productivity and quality standards.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The incumbent works under general supervision while keeping the needs of external and internal customers as a priority when making decisions and taking action. The incumbent communicates across a base of clients, members, and their employers. The successful individual in this role must be open to feedback, teamwork, and show a keen interest in contributing ideas to improve existing departmental processes. Decision making in the role is limited and must fall within established guidelines and may often end up being escalated to higher levels.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
Open
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