INSURANCE SUBROGATION/REIMBURSEMENT SPECIALIST, A20
Positions in this job family are assigned responsibilities related to identifying and protecting legal subrogation rights and recovering funds from responsible parties when possible. This includes reviewing claims and other information to identify possible third party responsibilities and initiating appropriate action to recover funds paid for various medical expenses and other costs.
The functions within this job family will vary by level, but may include the following:
The Insurance Subrogation/Reimbursement Specialist job family consists of three levels which are distinguished by the level of complexity, the extent of responsibility assigned, the level of expertise required and the responsibility assigned for the supervision of others.
Level I: Code: A20A Salary Band: H
This is the basic level where employees handle matters of a general nature with simple fact situations and routine legal involvement. This includes gathering pertinent data for use in determining the actual amounts paid on individual matters, communicating and corresponding with responsible parties, insurance carriers and attorneys, as well as policy holders, members, and payees and gathering necessary data on a routine basis for basic investigative purposes.
Knowledge, Skills and Abilities required at this level include knowledge of applicable rules and statutes, of the process and principles of insurance and of basic subrogation concepts. Ability is required to use personal computers to access standard data base; to communicate effectively with others, both orally and in writing; to establish and maintain effective working relationships with others.
Education and Experience requirements at this level consist of two years of technical experience which included the processing and/or payment of insurance claims or an equivalent combination of education and experience, substituting thirty semester hours of college for one year only of the required experience.
Level II: Code: A20B Salary Band: J
At this level employees handle subrogation matters of a complex nature, including contested matters as assigned. Responsibilities include maintaining diary system and reports on matters which are not routine, exercising independent judgment with regard to individual matters and reporting results as necessary, following up without specific direction on appropriate matters to achieve desired results. Responsibilities may include providing training and assistance to others in completing subrogation tasks and activities, compiling statistics, and preparing reports as required.
Knowledge, Skills and Abilities required at this level include knowledge of rules and regulations related to insurance subrogation; of agency policies and procedures; of insurance policies and provisions relating to negligence and liability, and modern office practices and equipment. Ability is required to use personal computers; to effectively communicate; to establish and maintain effective working relationships with others.
Education and Experience requirements at this level consists of those identified in Level I and two years of experience in subrogation or reimbursement in an insurance setting.
Level III: Code: A20C Salary Band: K
This is the leadership level where incumbents are responsible for supervision of lower level staff. This includes assigning work, inspecting results, reviewing job performance, approving leave and recommending personnel action. Responsibilities also include making recommendations to legal representatives, receiving assignments from legal staff, and reporting results.
Knowledge, Skills and Abilities required at this level include those identified in Level II plus the ability to effectively supervise others.
Education and Experience requirements at this level consist of those identified in Level II and two additional years of experience in subrogation or reimbursement in an insurance setting; or those identified in Level II and a current adjuster’s license in the area of casualty/liability claims.