Other Party Liability Specialist I
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.
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.
Benefits
- 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
- paid family leave program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
