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Subrogation Investigation Specialist

Cotiviti, Inc. • South Jordan, UT • 4h ago

Job Locations

US-Remote

2025-16745

Category

Customer Service/Retrieval Operations

Position Type

Full-Time

Overview

The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client's members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources. We are seeking a talented individual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement.

Responsibilities

You will work directly with our client's membership, insurance adjusters, and attorney's to:

Recovery Function - Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures:

Comply and be knowledgeable of all federal and state laws governing the collection of accounts.

Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to account.

Negotiate payment arrangements within established guidelines.

Investigative Function - Research claims as investigative support for the company to maximize profits of each account worked:

Determine if a case has third party liability potential.

Work collaboratively with internal and external contacts to determine account liability.

Assign file to a Recovery Specialist after detailing investigation claims.

Coordinate benefits with no fault and first party auto carriers.

Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements.

Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client.

Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details.

Investigative claims and accident details to identify recovery potential.

Update internal systems with information obtained and actions taken on account.

Ensure proper notification per client guidelines.

Effectively work, maintain, and manage a variety of cases with current and accurate notes.

Meet department objective standards for Customer Service.

Follow account process to ensure proper investigative steps are taken on each account.

Follow client and state guidelines for determining potential for recovery on behalf clients.

Develop templates for system training materials based on the training strategy.

Deliver specific application training based on use needs analysis.

Create and document training materials based on key functionality across the application.

Coordinate with product teams to keep training materials current with updated functionality and features.

Develop additional system support materials such as user job aids.

Complete all responsibilities as outlined in the annual performance review and/or goal setting.

Complete all special projects and other duties as assigned.

Must be able to perform duties with or wi

thout reasonable accommodation.

Qualifications

High School diploma or GED required.

Minimum 1-2 years experience in health insurance industry, medical claims, data entry, or customer service... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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