We are seeking a Casualty Case Management Specialist to manage all casualty and estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries. This role is responsible for the intake, maintenance, claims review, case management, settlement, and all related activities within the assigned caseload.
· Ensure all processes meet HIPAA and government security requirements regarding the sharing and storage of Personal Health Information (PHI).
· Utilize strong analytical and case management skills to oversee 700–1,000 subrogation cases simultaneously.
· Communicate professionally—primarily via inbound and outbound calls—with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients.
· Prepare and manage required correspondence, liens, claims, and related documentation throughout the recovery process.
· Meet departmental goals for customer service, settlements, and case handling standards.
· Perform both basic and advanced document and legal reviews to determine case status, ensure accuracy, and support workflow progression.
· Verify beneficiary eligibility and maintain accurate documentation.
· Confirm and validate third-party liability, probate, and asset research findings.
· Compile and analyze information from multiple sources to determine case status and recovery potential.
· Process and resolve claim or lien disputes; collaborate with attorneys and relevant stakeholders as needed.
· Conduct periodic follow-ups on case status, payments, and settlement updates.
· Negotiate and finalize claim or lien settlement amounts according to established contract guidelines.
· Execute and file notarized documents with applicable county offices.
· Prioritize case events, payment issues, and revenue-impacting deadlines to ensure timely resolution.
· Maintain accuracy, timeliness, and productivity standards for file management and phone metrics.
· 2+ years of relevant professional experience in subrogation, claims, or case management.
· Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
· Experience in a legal or insurance office setting (paralegal, legal assistant, casualty, or health insurance experience preferred).
· Familiarity with Medicaid and/or Medicare programs is preferred
· Video cameras must be used during all interviews and the initial week of orientation.
· Career growth and advancement opportunities are encouraged and supported.
· A company-provided computer is supplied for work use.
The deadline to submit applications for this posting is July 21, 2026
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For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.
Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.
Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.
