Other Party Liability Specialist

Blue Cross of Idaho•Bozeman, MT

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.

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.