Payment Integrity Manager - REMOTE

**Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace lines of business. This includes direct management of internal teams and external vendors handling both first-pass and second-pass recovery efforts. The role requires experience across a wide range of subrogation case types-including automobile-related claims (e.g., no-fault/PIP), workers' compensation, general liability, medical malpractice, and mass tort-with the ability to manage and optimize recoveries across all applicable third-party liability scenarios. **Key Responsibilities:** + Oversee subrogation operations, including internal teams and multiple vendor partners managing first-pass and second-pass recovery efforts. + Direct the identification, pursuit, and resolution of subrogation cases across a broad spectrum of liability types. + Develop and maintain policies, workflows, and escalation protocols to support efficient and compliant subrogation operations across Medicaid, Medicare, and Marketplace populations. + Collaborate with legal, claims, provider relations, finance, and compliance departments to ensure coordination and alignment on recovery efforts. + Monitor case outcomes and vendor performance to ensure recovery goals are met or exceeded. + Conduct regular quality assurance reviews of subrogation case files and provide coaching or corrective action as needed. + Analyze trends in recoveries and provide recommendations to improve operational effectiveness and financial performance. + Lead training, coaching, and development of subrogation staff to maintain high performance and technical knowledge. + Prepare performance dashboards, recovery reports, and operational updates for senior leadership. **Required Qualifications:** + 5+ years of experience in healthcare subrogation or legal recovery, including direct oversight of multiple subrogation case types. + 3+ years of experience in a leadership or management role, including responsibility for both internal staff and vendor oversight. + Experience working within a Managed Care Organization (MCO) or health plan environment. + Proven ability to manage complex vendor relationships and recovery strategies (e.g., first-pass and second-pass vendor models). + Strong understanding of federal and state regulations related to subrogation, including HIPAA, Medicaid TPL requirements, and CMS guidelines. + Excellent analytical, negotiation, communication, and team leadership skills. **Preferred Qualifications:** + Direct experience with subrogation in Medicaid, Medicare, and Marketplace lines of business. + Familiarity with QNXT claims processing platform. + Knowledge of legal procedures related to complex or litigated subrogation cases. Pay Range: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.