Third Party Liability Representative

Mass General Brigham•Somerville, MA

1d•$20 - $28•Remote

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 most 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. The Third-Party Representative will be responsible for investigating potential recoveries for third party liabilities through phone calls, questionnaires, claims, provider inquiries, ISO net, and other methods as required. This person will also be responsible for management of communications with internal and external parties, and high-level research work related to validation of subrogation. Deals directly with attorneys, providers, members, third party credit balance vendors and other insurers.

Requirements

High School Diploma or Equivalent required
At least 1-2 years of experience in healthcare billing, claims management, or third-party liability preferred
Knowledge of healthcare billing practices, insurance coordination, and claims processing.
Strong understanding of third-party liability regulations and claims processes.
Excellent communication and customer service skills.
Ability to handle sensitive information with discretion and confidentiality.
Strong problem-solving and analytical abilities.
Excellent organizational and multitasking skills with attention to detail and accuracy.
Clear communication and interpersonal skills.

Nice To Haves

Associate's Degree preferred

Responsibilities

Responsible for identifying recovery opportunities within the coordination of benefits/third party liabilities department.
Adhere to state statutes and regulations regarding medical liens including completing requests for liens/updated liens from attorneys as well as negotiating lien settlements with attorneys according to guidelines.
Research and process PIP/Worker’s Compensation claims.
Process TPL payments according to desktop procedures, contractual requirements, and other regulatory requirements.
Verify patient information and coverage details, and coordinate benefits between primary health insurance, third-party payers, and government programs.
Responsible for phone calls to or from members, providers, attorneys, and other auto insurance companies to gather MVA and Workers Comp information.
Act as liaison for all TPL-related inquiries and issues both internal and external to the organization.
Respond to providers, members and internal inquiries related to TPL cases.
Responsible for phone calls to or from members, providers, attorneys, and other auto insurance companies to gather MVA and Workers Comp information.