Other Party Liability Specialist I

Blue Cross of Idaho•Bozeman, MT

29d•$21 - $29

About The Position

Blue Cross of Idaho is seeking an Other Party Liability Specialist who will identify, investigate, and collects recoveries from third parties and other insurers who are legally responsible for paying all or part of medical expenditures. Interact with attorneys and third-party insurance professionals to explore where there may be a liability and negotiate and coordinate claim payments. What we are looking for: Experience: 2 years health industry, call center, claims, and/or collections experience. Here's what your day may look like: Prepares, researches, and analyzes claims reports to identify potential recoveries based on contract guidelines and corporate procedures. Responds to subrogation inquiries regarding third-party liability policies and procedures. Develops cases resulting from beneficiary and provider-initiated inquiries, internal referrals, personal research, and/or computer-generated reports. Negotiates recovery with customers, pharmacies, and other insurance carriers to maximize recovery potential, within established guidelines. Testifies at court hearings and represents the Company in mediations. Responsible to understand contractual obligations regarding other party liability cases, and assists enrollees, insurance companies, attorneys, and internal customers with prospective and current other party liability matters for all lines of business. Communicates with self-funded plan representatives to resolve issues regarding other party liability cases that are outside established guidelines. Reviews and processes drafts and/or checks and ensures accurate recordkeeping and reporting of activities. Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $20.93 to $29.29. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Blue Cross of Idaho has taken our role as an Idaho-based health insurance company to heart since 1945. As a not-for-profit, we are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services. We aim to create a brighter future for all with the help of customer-centric professionals. Your Health and Wellness Matters At Blue Cross of Idaho, we care about the health and well-being of our employees. Our benefits aim to help make your life easier, healthier and more balanced. Your Career Development Matters We believe in employee growth, which is why we offer training, tools and numerous resources to assist with professional development. Your Community Matters Our employees care deeply about Idaho. We work together to positively impact communities throughout Idaho, and contribute our time through volunteering. Blue Cross of Idaho will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully use electronic and online job application systems. For assistance, please send an email to [email protected]. Equal Opportunity is the Law EEO is the Law Supplement E-Verify Pay Transparency

Requirements

2 years health industry, call center, claims, and/or collections experience

Responsibilities

Prepares, researches, and analyzes claims reports to identify potential recoveries based on contract guidelines and corporate procedures.
Responds to subrogation inquiries regarding third-party liability policies and procedures.
Develops cases resulting from beneficiary and provider-initiated inquiries, internal referrals, personal research, and/or computer-generated reports.
Negotiates recovery with customers, pharmacies, and other insurance carriers to maximize recovery potential, within established guidelines.
Testifies at court hearings and represents the Company in mediations.
Responsible to understand contractual obligations regarding other party liability cases, and assists enrollees, insurance companies, attorneys, and internal customers with prospective and current other party liability matters for all lines of business.
Communicates with self-funded plan representatives to resolve issues regarding other party liability cases that are outside established guidelines.
Reviews and processes drafts and/or checks and ensures accurate recordkeeping and reporting of activities.
Performs other duties and responsibilities as assigned.