[Hiring] Subrogation Professional @Humana

Role Description

The Subrogation Professional 2 investigates accident, injury, and claim events to determine whether Humana may have the right to recover claim payments from another responsible party. This role gathers information from members, providers, insurance adjusters, attorneys, and other parties; reviews claim payments; creates liens; and negotiates repayment when appropriate. You will report to a Supervisor.

• Review new accident, injury, or claim events to determine whether subrogation or other party liability may apply.
• Contact members, providers, insurance adjusters, attorneys, and other involved parties by phone or email to gather claim details.
• Investigate the facts of the accident or claim, including:
  • What happened
  • Date and location of the accident or claim
  • Who was at fault
  • All parties involved
  • Insurance coverage information
  • Attorney or legal representation information
  • Settlement status, when applicable
• Use available resources to support the investigation, such as police reports, state websites, claim systems, provider information, and other approved resources.
• Identify and document responsible parties and provide appropriate notice of Humana’s potential recovery interest.
• Review claim payment information to determine amounts paid by Humana related to the accident or claim.
• Create, update, and maintain liens based on eligible paid claims.
• Communicate lien information to attorneys, adjusters, and other appropriate parties.
• Negotiate lien repayment amounts with attorneys or other parties as needed.
• Remain calm, professional, and confident during difficult conversations, including negotiations or disputed claims.
• Use emotional intelligence to manage conversations with members, attorneys, adjusters, and other parties in a respectful and effective manner.
• Document all conversations, research, actions taken, decisions made, and claim updates thoroughly and accurately in the appropriate systems.
• Follow up on outstanding claims, liens, documentation, settlement information, and recovery opportunities.
• Balance daily workload and create an effective workflow to manage competing priorities.
• Manage a high-volume workload while meeting monthly productivity, quality, and recovery expectations.
• Use multiple computer systems and applications to research claims, document activity, and complete daily work.
• Multitask effectively as work may come from multiple sources throughout the day.
• Work independently while knowing when to escalate complex issues or seek guidance.

Qualifications

• 2+ years of subrogation claims handling experience in healthcare, property and casualty, or worker's compensation insurance.
• 2+ years phone customer service experience dealing with escalated situations involving attorneys, providers, and/or members.
• Microsoft Office proficiency — ability to create forms, reports, and documents in Word and Excel.
• Experience multitasking within several computer systems throughout the day.
• Basic proficiency with computers, email, phone systems, and data entry.
• Strong verbal and written communication skills.

Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Humana provides medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.