Medical Claims Recovery Specialist (Subrogation) - Remote EST / CST

Summary

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others. 
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

What we're looking for

• 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

What you should expect in this role

• 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.
• To test your internet speed, go to Google and search for “Internet Speed Test.”

The deadline to submit applications for this posting is December 1, 2026.

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