Subrogation Program Specialist - Pembroke Pines, United States - Trova LLC

Description

• Define a clear strategy and the key priorities for the Subrogation program.
• Be accountable for the Subrogation targets achievement.
• Manage directly the most complex and high value subrogation cases.
• Support building and guarantee the right execution of the various action plans in close collaboration with the different involved Claims Teams.
• Design claims processes adaptation for maximizing our Subrogation opportunities in close collaboration with the Claims Team.
• Design automatic rules for Subrogation detection and guarantee their right and consistent implementation.
• Collaborate with UDW Team enabling to reinforce our Subrogation opportunities (e.g. coinsurance rules) in the T&Cs building / improvements.

• Define, on a collaboration mode, yearly Subrogation targets with each claims department.
• Consolidate on a regular basis a Subrogation Dashboard embedding savings but also operational KPIs split per department, Business Partners, type of claims
• Set up an adequate governance framework to review results, main cases, trends with the respective claims teams.
• Ensure timely and accurate Subrogation reporting for compliance and regulation purposes.

• Build and monitor dedicated action plans for each claim department.
• In close collaboration with Claims Teams, design and deploy Claims processes adjustments, in particular, at First Notification of Loss (FNOL) stage and allowing a:
• more systematic subrogation detection opportunity,

• Design and deploy specific and adapted eLearning modules for claims teams (jointly with the training department).
• Build and maintain a Subrogation Guideline including a clear and comprehensive articulation between the claims process and the full cycle time of a Subrogation case.

• Design automatic alerts for reinforcing Subrogation detection in the various Claims IT systems and guarantee their right and consistent implementation.
• Design / select a workflow capability for allowing an efficient monitoring of the Subrogation cases and guarantee its right and consistent implementation.

• Define a clear externalization strategy: types of Subrogation cases to be managed externally /internally.
• Manage the contractual relationship.
• Define clear KPIs and a clear Governance framework for driving the providers performance.

• Act as a Subrogation expert within the company, supporting peers to continuously improve maturity level.

• Minimum of 8 years of prior knowledge and experience in healthcare and/or insurance field for processing claims and or subrogation management.
• Strong analytical skills required including demonstrated ability to analyze raw data, draw conclusions, and develop actionable recommendations.
• Knowledge of developing standards, procedures, guidelines etc.
• A minimum of 3 years' experience in a management or supervisory role is preferred.
• Must be able to represent the organization in a professional and knowledgeable manner.
• Excellent verbal and written communication skills with ability to manage and prioritize multiple tasks.
• Computer skills necessary to work effectively: Windows Microsoft Word, Excel, and Power Point Proven ability to work under pressure, prioritize work and meet multiple deadlines.
• Excellent interpersonal and relationship building skills with a proven track record of leadership across functional lines that delivers business results.
• Excellent problemsolving skills and capability to troubleshoot the most difficult claim issues.

• High School Diploma or Equivalent (GED) required.

• Associate's degree or equivalent

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

• Monday to Friday

• Pembroke Pines, FL 33027: Relocate before starting work (required)