You are here

Insurance Subrogation/Reimbursement Specialist

A20

Basic Purpose

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.

Typical Function

The functions within this job family will vary by level, but may include the following:

  • Determines in individual cases where possibilities for subrogation and recoveries exist.
  • Applies rules and statutes to fact situations to identify possible resources on which to base a demand for reimbursement from third party payers.
  • Uses available resources to investigate claim situations and identify other entities and individuals with resources against which subrogation or recovery claims can be made.
  • Reviews and evaluates accident or incident reports, individual claims, medical or other documents relating to funds paid out by an agency.
  • Notifies other parties and insurance carriers or attorneys of the agency’s subrogation or recovery interest; confers with other parties, insurance carriers and attorneys concerning potential settlement or other actions; advises insiders or policy holders regarding agency subrogation interests, policies and procedures.
  • Represents the agency in meetings concerning subrogation matters; negotiates settlements of subrogation claims; makes recommendations to obtain final approval.
  • Prepares and maintains case files, correspondence, legal documents and other information related to subrogation claims; participates in or coordinates actions involving accounting for payments received.

Level Descriptors

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.