Medical Claims Recovery Specialist

Join Gainwell Technologies as a Medical Claims Recovery Specialist managing casualty and estate functions related to Medicaid beneficiaries. Responsibilities include intake, claims review, case management, settlement, and all related activities within assigned caseloads. You'll ensure compliance with HIPAA and security requirements related to Personal Health Information (PHI).

Use strong analytical and case management skills to oversee 700–1,000 subrogation cases simultaneously. Communicate professionally via calls with attorneys, insurance adjusters, medical providers, court staff, recipients, and family members. Prepare and manage correspondence, liens, claims, and documentation throughout recovery processes.

Perform document and legal reviews to determine case status and accuracy. Verify beneficiary eligibility and validate third-party liability and asset research findings. Compile and analyze multiple information sources to determine case status and recovery potential. Resolve claim or lien disputes collaborating with attorneys and stakeholders. Negotiate and finalize settlements according to contract guidelines. Execute and file notarized documents with county offices.

Prioritize case events, payment issues, and deadlines to ensure timely resolution. Maintain accuracy, timeliness, and productivity for file management and phone metrics.