Legal Case Manager

This is a fully remote position, open to applicants in Alabama, +11 more states.

📋 Description

• Assess, investigate, and manage requests for member claims records that involve Protected Health Information (PHI).

• Process and fulfill requests directed to Aetna for access to member PHI.

• Confirm that all legal, regulatory, privacy, and authorization conditions are met before disclosing records.

• Review and authenticate request documentation to establish eligibility for disclosure.

• Oversee and manage subpoenas, court orders, law enforcement inquiries, regulatory requests, legal access requests, member and provider authorizations, personal representative requests, and other legally permissible disclosures.

• Investigate and address complex or unusual member rights, disclosure, and privacy requests.

• Refer issues needing legal, compliance, or privacy assessment to the appropriate parties.

• Maintain the confidentiality and security of sensitive member information while complying with established policies, procedures, and internal controls.

⛳️ Requirements

• Proficient in problem-solving and decision-making skills.

• 2-5+ years of experience working with Protected Health Information (PHI).

• Strong verbal and written communication abilities.

• Familiarity with HIPAA Privacy Rule requirements.

• Experience in reviewing and interpreting legal documents, subpoenas, court orders, authorizations, and regulatory correspondence.

• High School Diploma or Equivalent Experience (REQUIRED).

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial health, based on eligibility.