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The Subrogation Representative 3 is responsible for identifying, investigating, and recovering funds from third parties who are legally liable for medical expenses. This role collaborates with attorneys and insurance professionals to assess liability and ensures accurate maintenance of Coordination of Benefits (COB) records. The associate supports compliance with subrogation policies and procedures while delivering high-quality service and maintaining confidentiality of member information. This position reports to a Supervisor within the Subrogation Department.
Key Responsibilities
- Review and process subrogation correspondence and referrals within CRM systems (CAS/MTV) to determine appropriate handling under Third-Party Liability guidelines.
- Validate and match member information in CAS/MTV to ensure accurate case identification and documentation.
- Create and manage cases/events in Troveris to support recovery efforts from attorneys, insurance carriers, and other responsible parties.
- Generate and send outbound correspondence using the EMME system in accordance with established workflows and timelines.
- Handle outbound calls using the Genesys system to communicate with third parties, obtain additional information related to correspondence received, and determine appropriate handling for cases involving non-pursuable member groups.
- Assess liability details and supporting documentation to identify subrogation opportunities and support recovery strategies.
- Ensure accurate documentation and timely updates across CRM, Troveris, and EMME systems for all case activities.
- Route cases appropriately to Subrogation, Other Party Liability, Coordination of Benefits, or other departments based on established guidelines.
- Manage a high-volume, production-driven workload while meeting quality, accuracy, and compliance standards, including HIPAA and data privacy requirements.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families, including:
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
Use your skills to make an impact
Required Qualifications
- 1+ year of experience in healthcare and/or subrogation experience in the property, casualty, or worker's compensation fields.
- 2+ years of experience in a call center and/or production environment.
- Experience assessing severity of support requests and escalate based on severity.
- MS Proficiency - Ability to create forms, reports, and documents in Word and Excel.
- Typing and computer navigation skills, including use of multiple computer applications simultaneously.
- Strong organizational abilities.
Preferred Qualifications
- Undergraduate Degree
- Bilingual in English/Spanish
- Claims Processing Experience
Additional Information
Work-At-Home Requirements
- To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Our Hiring Process
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment (10-15 minutes).
Compensation
- Scheduled Weekly Hours: 40
- Pay Range: $34,400 - $45,000 per year (varies based on experience, location, and skills).
About Us
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. #LI-LM1