Manager, Recoveries

Mass General Brigham•Somerville, MA

4d•Hybrid

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Responsible for managing the Coordination of Benefits and Third Party Liability organizations. Oversee the process of recovering funds from other health insurance plans and liable third parties for claim-related expenses and ensuring compliance with relevant laws and regulations. Lead the identification of responsible parties, evaluation of claims, and manage the end-to-end recovery process, often working with insurance companies, attorneys, and other stakeholders. This role also involves supervising staff, developing and implementing strategies to optimize cost recovery, and maintaining accurate records while ensuring that all recovery efforts are conducted in compliance with the organization's policies and regulatory requirements.

Requirements

Bachelor's Degree required; experience can be considered in lieu of a degree
At least 5-7 years of experience in COB, TPL, and claims adjudication experience required
At least 2-3 years of experience in a supervisory or leadership role required
Strong knowledge of health insurance claims, coordination of benefits, and third-party liability.
Excellent leadership, organizational, and team management skills.
Proficiency in using health plan software and tools.
Strong analytical and problem-solving skills with attention to detail.
Effective communication and interpersonal skills.

Nice To Haves

At least 2-3 years of experience within a health plan setting preferred

Responsibilities

Oversee the Coordination of Benefits and Third Party Liability processes for recovering funds related to COB and TPL claims.
Develop and implement strategies to maximize recovery rates and minimize revenue loss.
Manage, mentor, and train the Recoveries Team to ensure efficient and effective handling of accounts.
Conduct performance evaluations, provide feedback, and support professional development for team members.
Review and analyze denied claims and billing issues to determine the root cause and appropriate course of action.