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Identifies subrogation opportunities for workers’ compensation and property/auto claims, negotiates settlements with insurers and attorneys, sends lien notices, tracks claim status, communicates with stakeholders, researches subrogation laws, and manages a 250–300 claim queue. The role also supports inter-company arbitration and maintains client relationships while following client guidelines and participating in claim reviews.

Develops and deploys production machine learning models and data products for enterprise use. Responsibilities include data mining, feature engineering, model evaluation, NLP and LLM/RAG solutions, API and pipeline integration, cloud-based deployment, model validation, A/B testing, documentation, and lifecycle management. The role translates business needs into scalable data science solutions and collaborates with product, engineering, and business stakeholders throughout the SDLC.

Prepare, review, and submit Workers' Compensation EDI FROI and SROI filings using vendor platforms. Analyze claim data, interpret state-specific EDI implementation guides and reporting rules, resolve transaction errors/rejects, monitor compliance with deadlines, communicate with internal stakeholders, and ensure HIPAA and regulatory compliance.

Supervise hospital bill audit nurses, ensuring accurate audits and compliance with regulations. Foster team collaboration and handle auditor inquiries while maintaining productivity standards.

The Appeals Representative analyzes appeals in accordance with policies and guidelines, communicates with providers, and ensures timely completion of appeals while adhering to industry standards.