Medicaid Sr. Caseworker (Hybrid - Raleigh, NC)

Summary

HMS works to make the healthcare system better for everyone. We identify and prevent fraud, waste, and abuse so individuals can access the care they need—now and in the future. Through innovative technology and powerful data analytics, we help government and commercial payers reduce costs, improve quality, and meet regulatory requirements. We also empower consumers to take a more active role in their health. Each year, we save our clients billions of dollars while supporting healthier communities.
At HMS, you will have the opportunity to develop new skills, grow your career in a dynamic industry, and make a meaningful difference in the lives of others.
We are seeking a detail-oriented and motivated Case Management Assistant (Onsite). This role is responsible for verifying, documenting, and coordinating information required to process applications and case management assignments. Responsibilities include confirming third-party liability, validating documentation, coordinating with employers, and providing high-quality customer service while ensuring accurate data entry, timely processing, and compliance with program requirements.

Your role in our mission

•    Provide enrollment support and HIPP/Premium Assistance program information to Medicaid-eligible individuals and their families via phone.
•    Verify, document, and investigate healthcare coverage for Medicaid recipients and their dependents.
•    Identify members who may qualify for the HIPP/Premium Assistance program.
•    Complete periodic and ad-hoc reports as required.
•    Handle high-volume customer service calls, including inquiries about the HIPP/Premium Assistance program.
•    Perform accurate and timely data entry.
•    Obtain and/or verify all documentation required for eligibility and enrollment into the HIPP/Premium Assistance program.
•    Maintain active cases during open enrollment and premium review periods to support revenue and program growth.
•    Independently manage a variety of cases of differing complexity within established service level agreements.
•    Conduct outgoing follow-up calls regarding case status, payments, or outstanding requirements.
•    Perform advanced document review, case status identification, basic legal research, and escalate issues when necessary.
•    Prioritize and manage all case events and critical payment/recovery tasks while meeting internal and regulatory deadlines.
•    Interact professionally with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and internal clients.

What we're looking for

• 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 (Estate recovery or casualty preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred

What you should expect in this role

•    Hybrid work arrangement based in the Raleigh, Norrth Carolina office — onsite 2 days per week.
•    Schedule: Monday–Friday, 8:00 AM – 5:00 PM.
•    Video cameras are required during all interviews and throughout the first week of orientation.
•    To work effectively as a teleworker or hybrid employee, you must have broadband internet with a minimum speed of 24 Mbps download and 8 Mbps upload (higher speeds recommended for optimal performance).

This posting is intended for pipelining. We will accept applications on an ongoing basis.

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