Subrogation Specialist
Acrisure, San Diego, CA, United States
About Acrisure
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting‑edge technology and top‑tier human support together, we connect clients with customized solutions across insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. Acrisure has grown from $38 million to almost $5 billion revenue in twelve years and employs over 19,000 colleagues in more than 20 countries. It prioritizes leadership, accountability, and collaboration.
Job Summary
Acrisure is seeking an Appeal/Subrogation Specialist for the growing SBMA team. SBMA is an affordable ACA‑compliant benefits provider. The specialist is critical in the Claims Department, responsible for managing and resolving appeals, coordinating subrogation opportunities, and ensuring recovery of claim costs on behalf of clients.
Responsibilities
Review and evaluate appeal requests to determine validity, compliance, and next steps.
Analyze claim files, medical records, payment history, EOBs, and policy/plan documents to support decision-making.
Prepare clear, thorough, and defensible written appeal determinations within regulatory timelines.
Communicate with claimants, providers, carriers, and internal departments to gather information and resolve discrepancies.
Maintain accurate documentation in the claims system and ensure all regulatory and contractual requirements are met.
Identify and evaluate potential subrogation opportunities through claim reviews, incident reports, and liability indicators.
Initiate and manage subrogation inquiries with involved parties, including adverse carriers, attorneys, employers, and vendors.
Ensure all appeal and subrogation activities comply with federal/state regulations (ERISA, state workers’ compensation laws, HIPAA).
Work closely with claims examiners, supervisors, and client service teams to support effective claim resolution.
Respond to inquiries from clients, members, providers, and external representatives with professionalism and clarity.
Requirements
Strong analytical skills and attention to detail.
Ability to interpret policies, regulations, and complex documentation.
Proficiency with claims management systems and Microsoft Office.
Advanced Excel and reporting skills.
Excellent verbal and written communication skills.
Ability to handle sensitive information with confidentiality.
Strong problem‑solving skills and ability to think critically under pressure.
Able to work independently while coordinating with multiple departments.
Education And Experience
2+ years of experience in claims management, appeals, subrogation, or related insurance/TPA functions.
Knowledge of claims processes.
Expert‑level proficiency in HealthPac.
Experience in a TPA environment preferred.
Pay Details
The base compensation range for this position is $20,000 – $25,000. Placement within the range will depend on skills, experience, qualifications, location, and internal equity.
On‑site Presence
Candidates should be comfortable with an on‑site presence to support collaboration, team leadership, and cross‑functional partnership.
Employee Benefits
Physical Wellness: comprehensive medical, dental, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
Mental Wellness: generous paid time off and holidays; Employee Assistance Program; and a complimentary Calm app subscription.
Financial Wellness: immediate vesting in a 401(k) plan; Health Savings Account and Flexible Spending Account options; commuter benefits; and employee discount programs.
Family Care: paid maternity and paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.
… and so much more (eligibility and waiting periods may apply).
Equal Opportunity Employer
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.
Other Information
Final candidates will be required to complete post‑offer verification processes related to the role and in accordance with applicable laws.
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A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting‑edge technology and top‑tier human support together, we connect clients with customized solutions across insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. Acrisure has grown from $38 million to almost $5 billion revenue in twelve years and employs over 19,000 colleagues in more than 20 countries. It prioritizes leadership, accountability, and collaboration.
Job Summary
Acrisure is seeking an Appeal/Subrogation Specialist for the growing SBMA team. SBMA is an affordable ACA‑compliant benefits provider. The specialist is critical in the Claims Department, responsible for managing and resolving appeals, coordinating subrogation opportunities, and ensuring recovery of claim costs on behalf of clients.
Responsibilities
Review and evaluate appeal requests to determine validity, compliance, and next steps.
Analyze claim files, medical records, payment history, EOBs, and policy/plan documents to support decision-making.
Prepare clear, thorough, and defensible written appeal determinations within regulatory timelines.
Communicate with claimants, providers, carriers, and internal departments to gather information and resolve discrepancies.
Maintain accurate documentation in the claims system and ensure all regulatory and contractual requirements are met.
Identify and evaluate potential subrogation opportunities through claim reviews, incident reports, and liability indicators.
Initiate and manage subrogation inquiries with involved parties, including adverse carriers, attorneys, employers, and vendors.
Ensure all appeal and subrogation activities comply with federal/state regulations (ERISA, state workers’ compensation laws, HIPAA).
Work closely with claims examiners, supervisors, and client service teams to support effective claim resolution.
Respond to inquiries from clients, members, providers, and external representatives with professionalism and clarity.
Requirements
Strong analytical skills and attention to detail.
Ability to interpret policies, regulations, and complex documentation.
Proficiency with claims management systems and Microsoft Office.
Advanced Excel and reporting skills.
Excellent verbal and written communication skills.
Ability to handle sensitive information with confidentiality.
Strong problem‑solving skills and ability to think critically under pressure.
Able to work independently while coordinating with multiple departments.
Education And Experience
2+ years of experience in claims management, appeals, subrogation, or related insurance/TPA functions.
Knowledge of claims processes.
Expert‑level proficiency in HealthPac.
Experience in a TPA environment preferred.
Pay Details
The base compensation range for this position is $20,000 – $25,000. Placement within the range will depend on skills, experience, qualifications, location, and internal equity.
On‑site Presence
Candidates should be comfortable with an on‑site presence to support collaboration, team leadership, and cross‑functional partnership.
Employee Benefits
Physical Wellness: comprehensive medical, dental, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
Mental Wellness: generous paid time off and holidays; Employee Assistance Program; and a complimentary Calm app subscription.
Financial Wellness: immediate vesting in a 401(k) plan; Health Savings Account and Flexible Spending Account options; commuter benefits; and employee discount programs.
Family Care: paid maternity and paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.
… and so much more (eligibility and waiting periods may apply).
Equal Opportunity Employer
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.
Other Information
Final candidates will be required to complete post‑offer verification processes related to the role and in accordance with applicable laws.
#J-18808-Ljbffr