Job Description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

We are seeking a talented individual for a Casualty Case Management Specialist who is responsible for processing all casualty or estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, management, settlement, and 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

What we're looking for

• Medicaid and/or Medicare knowledge preferred
• Ability to interact with all levels of people both internally and externally in a professional manner
• Ability to be careful and thorough about detail including with cite-checking and proofreading skills
• Ability to multitask and prioritize effectively
• Knowledge of Microsoft Word and Excel required
• Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required
• Basic knowledge of Microsoft Access preferred
• Ability to work independently to meet objectives
• Ability to analyze information and use logic to address work-related issues and problems
• Ability to perform well in team environment, to achieve business goals
• Ability to maintain a high level of confidentiality and ethics
• Ability to handle pressure and manage deadline-oriented project demands and multiple initiatives
• Two years of relevant experience 
• Experience in a Legal office preferred; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) preferred

What you should expect in this role

Remote position

#LI-REMOTE

#LI-NA1

The pay range for this position is $26,500 - $37,800 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies  is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. 

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