[Hiring] Medical Claims Recovery Specialist @Gainwell Technologies LLC

Role Description

We are seeking a talented individual for a Senior Subrogation Case Worker role, who is responsible for processing all probate and estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes:

• Intake, maintenance, claims review and selection, asset investigation, court filings and deadline management, settlement and other related functions to the case.

Your role in our mission:

• Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).
• Utilize complex analytical skills to manage subrogation cases, notate files and negotiate settlements on 700 to 1,000 cases at a time.
• Interact professionally, primarily using incoming and outgoing calls, with attorneys, insurance adjusters, medical providers, court staff, recipients and family members, and clients.
• Prepare required correspondence, liens, claims, and other related documents to progress the case to recovery.
• Meet department objective standards for Customer Service, settlement goals, and file handling guidelines.
• Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow.
• Confirm documentation of eligibility for beneficiaries.
• Conduct all case document review and updates as needed.
• Confirm and validate third party liability, probate, and beneficiary asset research.
• Compile, analyze, and make conclusions about case information and status from multiple sources.
• Process all claim/lien disputes and review claims with attorneys and other stakeholders.
• Conduct outgoing periodic follow up on case status and payment.
• Negotiate and compromise claim/lien settlement amounts per contract guidelines.
• Sign and file notarized documents with counties on applicable cases.
• Prioritize case events and critical case payment/recovery issues, while meeting various internal and legal deadlines that are revenue impacting.
• Meet file handling and phone call metrics related to each case.

Qualifications

• 2+ years of relevant professional experience in subrogation, claims, or case management.
• Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
• Experience in a legal or insurance office setting (paralegal, legal assistant, casualty, or health insurance experience preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred.

Requirements

• Must reside in the Eastern or Central Time Zone and be available to work business hours aligned with those time zones.
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• The deadline to submit applications for this posting is December 1, 2026.

Benefits

• The pay range for this position is $24,700.00 - $35,300.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• A variety of leadership and technical development academies to help build your skills and capabilities.