Job Description

The Subrogation Specialist will review and analyze large data sets, including medical and pharmacy claims, eligibilities and medical documents looking for subrogation opportunities and start a contestation process with the Health Plan.

Essential Duties and Responsibilities

  • Provide subrogation and workers compensation recovery services, and Medicare COB (coordination of benefits) claims review and recovery services.
  • Identify subrogation liens and initiate the appropriate collection procedures, as developed with legal counsel.
  • Collaborate with internal personnel, external stakeholders, and legal teams to facilitate subrogation recovery efforts.
  • Maintain detailed documentation of subrogation cases, including correspondence, payments, and resolutions.
  • Generate reports on subrogation recovery activities and coordination of benefits verification for internal analysis.
  • Ensure compliance with CMS guidelines and regulations related to the above-described processes.
  • Stay updated on changes in Medicare Advantage requirements and implement necessary adjustments to operational procedures.


  • Bachelor's degree
  • Preferred minimum of 2 years of experience in Medicare Advantage programs, coordination of benefits, subrogation, or similar roles.
  • Exceptional organizational skills
  • Excellent communication skills, both written and verbal, with the ability to effectively communicate with external stakeholders.

Disclaimer - This job description is intended to convey information essential to understanding the scope of the position and is not exhaustive. Duties and responsibilities may be subject to change based on organizational needs and priorities.