Third Party Liability (TPL) Lead

BerryDunn•Remote,

6d•Hybrid

About The Position

BerryDunn is seeking a Third Party Liability (TPL) Lead to support Hawaiʻi Med-QUEST’s Third Party Liability, Fraud, Waste, and Abuse (FWA), program integrity, and Medicaid TPL initiatives. This role will lead TPL operations, including cost avoidance, recovery, lien-related processes, vendor coordination, reporting, quality assurance, and operational improvements. The TPL Lead will oversee the TPL Subject Matter Expert (SME) and coordinate closely with the Program Integrity Lead and Policy Lead to align TPL work with program integrity, audit, policy, process, and systems priorities. This role will help ensure Medicaid acts as the payer of last resort by supporting coordination and recovery from liable third parties, including commercial insurers, Medicare, and casualty or liability carriers. The TPL Lead will work within our project structure, with close coordination across Integrated IT, Process & Policy, Strategic Project Management, and Learning, Development & Change Management workstreams. Travel expectations: This role may require travel up to 25% of the year.

Requirements

Experience leading or supporting Medicaid Third Party Liability (TPL), program integrity, recovery, cost avoidance, audit, compliance, policy, or related operations.
Strong knowledge of Medicaid coordination of benefits, third-party payer data, recovery processes, lien-related processes, federal and state TPL requirements, and payer-of-last-resort principles.
Experience coordinating TPL-related work across program, vendor, legal, finance, policy, analytics, claims, eligibility, audit, and project management stakeholders.
Experience interpreting and applying federal and state Medicaid requirements.
Strong project leadership, facilitation, communication, analytical, and stakeholder engagement skills.
Ability to analyze Medicaid claims, eligibility systems, third-party payer data, recovery opportunities, and operational improvements.
Experience leading or supporting business process redesign in a Medicaid, healthcare, claims, eligibility, program integrity, or TPL environment.
Experience overseeing or coordinating the work of subject matter experts, analysts, or project team members.
Ability to collaborate across multidisciplinary workstreams, including strategic project management, integrated IT/process/policy, audit, operations, training, communications, and change management teams.
Minimum three (3) years of experience within the last five (5) years in a comparable Medicaid, healthcare, TPL, program integrity, operations, leadership, or consulting role.

Nice To Haves

Experience supporting or leading a state Medicaid agency TPL program, including cost avoidance, recovery, casualty/liability, lien-related processes, audit, compliance, coordination of benefits, or vendor coordination.
Experience supporting implementation activities such as process redesign, reporting, testing, training readiness, release coordination, performance monitoring, or stabilization.
Familiarity with Medicaid eligibility systems, claims systems, integrated eligibility systems, or vendor-managed Medicaid data environments is a plus.

Responsibilities

Lead TPL operations and improvements, including cost avoidance, recovery, lien-related processes, vendor coordination, reporting, and quality assurance.
Oversee the TPL SME’s work, including analysis, recommendations, documentation, operational support, and quality review.
Coordinate with the Program Integrity Lead and Policy Lead to align TPL activities with broader compliance, audit, policy, process, and systems priorities.
Provide guidance to project teams and stakeholders on Medicaid TPL requirements, best practices, operational considerations, and compliance expectations.
Support daily TPL Unit operations, including coordination with MQD units, vendors, health plans, the Civil Recoveries Division, and other partners.
Lead or support development, tracking, and refinement of TPL lien-related processes and documentation.
Facilitate meetings, manage follow-up actions, track decisions, escalate risks and blockers, and support timely issue resolution.
Review existing TPL processes and lead business process redesign to improve efficiency, compliance, accountability, and recovery outcomes.
Review TPL vendor lead files, verified policy updates, cost avoidance reports, recovery reports, and related operational data.
Follow project ways-of-working standards, including document management, client communication, time entry, internal review cycles, and protection of sensitive information.