Remote Medical Claims Processor Jobs in Pawtucket, RI

Job Summary
The Senior Subrogation Specialist is responsible for the technical evaluation, negotiation, and settlement of complex subrogation files regardless of the recovery or intake channel. Primary functions include identifying and pursuing recovery opportunities (Outbound), resolving incoming carrier demands (Inbound), and managing the full lifecycle of Arbitration filings. The specialist manages a diverse portfolio-including Medpay Trust, Government, and specialized loss types-while serving as a formal Arbitration Panelist to resolve industry disputes.
Job Duties

• Arbitration Prep & Filing: Prepare and file high-quality intercompany arbitration contentions through Arbitration Forums (Arb Forums) when negotiations reach an impasse, ensuring all legal theories and evidence are accurately presented.

• Litigation & Vendor Management: Manage and oversee all litigated subrogation files, coordinating with legal counsel to manage complex legal issues while monitoring and managing vendors for Medpay Trust, Property, Product Liability, and complex legal issues.

• Universal Communication & Negotiation: Communicate and interact with third-party insurance carriers, legal counsel, government entities, and internal stakeholders to review, negotiate, and resolve high-complexity inbound subrogation demands and outbound recovery efforts.

• Specialized Loss Recovery: Identify and pursue recovery for specialized losses, including Medpay Trust, Property, Watercraft, Motorcycle, commercial semi-truck, Government, and Product Liability claims.

• Technology & Systems: Utilize E-Subro Hub, Arbitration Forums, and specialized claims/appraisal systems to facilitate the electronic exchange of documentation and high-limit payment processing.

• Arbitration Industry Leadership: Serve as a required Arbitration Forums (AF) Panelist, reviewing and deciding on complex intercompany arbitration cases filed by other member carriers.

• Liability & Damage Assessment: Evaluate and determine liability and damages for high-complexity files across all markets, specifically addressing comparative liability disputes, policy limit issues, and negligence principles.

• Evidence & Verification: Identify and obtain necessary internal and external documentation, including police reports, repair estimates, and payment histories, to verify the accuracy of third-party demands or support liability arguments and recovery demands.

• Inbound Technical Review: Review and validate incoming demands involving specialized handling for Watercraft, Motorcycle, commercial semi-truck, and Real Property losses to ensure they meet "Straight Through" processing criteria.

• Member Advocacy: Proactively contact insured members to provide status updates on subrogation and recovery efforts, specifically regarding the status of their deductible recovery and reimbursement.

• Administrative Excellence: Maintain accurate records in all specialized subrogation systems to track productivity, savings, recovery rates, and file quality.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred

• 4-6 years 3+ years of claims liability experience required. Required

• Previous experience with E Subro Hub and Arbitration Forums required. (High proficiency)

• Advanced knowledge of claims administration, subrogation principles, and negligence laws across all markets. (High proficiency)

• Excellent written communication skills required for drafting complex arbitration contentions and legal correspondence. (Medium proficiency)

• Proficient in Microsoft Office suite, claims systems, appraisal systems, and E-Subro Hub. (High proficiency)

• Organization and planning proficiency required to manage complex litigation and arbitration timelines. (High proficiency)

• Advanced interpersonal and negotiation skills. (Medium proficiency)

• Successful completion of Foundation and Arbitration Handling training. (High proficiency)

• Property and Casualty Insurance License, valid in selling state - Issued by State P&C Insurance License required for Texas; must have the ability to obtain NH, VT, and KY licenses based on business need. Required

Travel Requirements

• Occasional travel to off-site business meetings or conferences (5% proficiency)

The starting pay range for this position is $64,500 - $86,100 annually. Additionally, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

Remarkable benefits:

Health coverage for medical, dental, vision

401(K) saving plans with company match AND Pension

Tuition assistance

Floating holidays and PTO for community volunteer programs

Paid parental leave

Wellness programs

Employee discounts (membership, insurance,

travel, entertainment, services and more!)

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value."

AAA is an Equal Opportunity Employer

Our organization participates in E-Verify