Manager, Government Programs Third Party Liability and Coordination of Benefits

Delta Dental of Michigan•Okemos, MI

1d•Remote

About The Position

Provides strategic leadership and operational oversight of Government Programs Third Party Liability operations (TPL) and Coordination of Benefits (COB) to ensure accurate identification, coordination, recovery and reporting of third-party coverage in compliance with federal and state Medicare and Medicaid regulations. Leads the end-to-end Government Programs TPL/COB strategy, cost avoidance, post-payment recovery, and vendor management, ensuring program performance meets contractual, regulatory, and financial objectives. Designs, documents, and implements TPL/COB policies, procedures and workflows aligned with CMS Medicare and state Medicaid requirements, translating regulatory requirements into operational practice. Develops, monitors, and reports key performance metrics related to recoveries, cost avoidance savings, and accuracy; drives accountability through regular performance reviews and action planning. Identifies and executes opportunities to improve TPL/COB recovery yield, increase automation, strengthen controls, and enhance overall operational efficiency across TPL/COB processes. Serves as the Government Programs TPL/COB subject matter expert, providing guidance on benefit coordination, payment order, recovery methodologies, and operational interpretation of regulatory requirements. Champions TPL/COB processing enhancements and cross-functional initiatives that advance Government Programs goals, including system improvements, workflow redesign, and change management adoption. Partners with business and technology stakeholders to define and deliver the TPL/COB strategic roadmap, including requirements definition, prioritization, implementation planning, and clear communication of impacts to affected teams. Leads and coordinates support for CMS, state and other regulatory audits and reviews related to TPL/COB, including data requests, documentation, issue remediation, and ongoing compliance monitoring. Interviews, hires, trains, develops, and evaluates staff in order to ensure accountability for the achievement of corporate and department goals and objectives.

Requirements

Bachelor’s degree in healthcare administration, business administration, finance or a related field, or any suitable combination of education, training, or experience.
Seven years of government programs third party liability/coordination of benefits experience.
Three years of leadership experience.
Advanced knowledge, experience and understanding of state and federal regulations related to TPL/COB for government programs including Medicare and Medicaid.
Strong verbal and written communication skills, including the ability to present on behalf of the organization.
Strong interpersonal skills.
Strong analytical skills.
Strong advocacy skills.
Ability to identify and partner with key business leaders.
Ability to lead and motivate others.
Ability to identify and resolve the most complex TPL/COB related issues using independent judgment.
Ability to work under pressure and manage multiple complex priorities.

Responsibilities

Provides strategic leadership and operational oversight of Government Programs Third Party Liability operations (TPL) and Coordination of Benefits (COB).
Ensures accurate identification, coordination, recovery and reporting of third-party coverage in compliance with federal and state Medicare and Medicaid regulations.
Leads the end-to-end Government Programs TPL/COB strategy, cost avoidance, post-payment recovery, and vendor management.
Ensures program performance meets contractual, regulatory, and financial objectives.
Designs, documents, and implements TPL/COB policies, procedures and workflows aligned with CMS Medicare and state Medicaid requirements.
Develops, monitors, and reports key performance metrics related to recoveries, cost avoidance savings, and accuracy.
Drives accountability through regular performance reviews and action planning.
Identifies and executes opportunities to improve TPL/COB recovery yield, increase automation, strengthen controls, and enhance overall operational efficiency.
Serves as the Government Programs TPL/COB subject matter expert.
Provides guidance on benefit coordination, payment order, recovery methodologies, and operational interpretation of regulatory requirements.
Champions TPL/COB processing enhancements and cross-functional initiatives.
Partners with business and technology stakeholders to define and deliver the TPL/COB strategic roadmap.
Leads and coordinates support for CMS, state and other regulatory audits and reviews related to TPL/COB.
Interviews, hires, trains, develops, and evaluates staff.