Legal Case Manager

This position serves as a critical compliance and operational resource responsible for reviewing, researching, validating, and processing requests for member Protected Health Information (PHI). The role ensures compliance with HIPAA, applicable state privacy laws, regulatory requirements, and organizational policies by determining whether requests for access to, use of, or disclosure of PHI are legally permissible and properly authorized prior to the release of records. Responsibilities include supporting member rights requests, legal access requests, subpoenas, court orders, regulatory inquiries, law enforcement demands, and other authorized disclosures of health information

What you will do:

Review, research, and process requests for member claims records involving Protected Health Information (PHI), ensuring compliance with HIPAA, state privacy laws, company policies, and regulatory requirements.

Process and fulfill requests submitted to Aetna seeking access to member Protected Health Information (PHI), ensuring all legal, regulatory, privacy, and authorization requirements have been satisfied before records are disclosed.

Review and validate request documentation to determine eligibility for disclosure and confirm compliance with applicable federal and state regulations.

Manage and process requests received through: Subpoenas and court orders Law enforcement requests and demands Regulatory agency inquiries and requests Legal Access requests Member and provider authorizations Personal representative requests Other legally permitted disclosures of Protected Health Information

Subpoenas and court orders

Law enforcement requests and demands

Regulatory agency inquiries and requests

Legal Access requests

Member and provider authorizations

Personal representative requests

Other legally permitted disclosures of Protected Health Information

Research and resolve complex or non-routine member rights, disclosure, and privacy requests, escalating matters requiring legal, compliance, or privacy review.

Ensure confidentiality and security of sensitive member information while adhering to established policies, procedures, and internal controls.

Required Qualifications

Working knowledge of problem solving and decision making skills

2-5+ years’ work experience with Protected Health Information (PHI)

Excellent verbal and written communication skills

Preferred Qualifications

Working knowledge of HIPAA Privacy Rule requirements

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

Education

High School Diploma or Equivalent Experience (REQUIRED)