Third Party Liability Representative

You may choose to display a cookie banner on the external site. You must specify the message in the cookie banner and may add a link to a relevant policy. If you are unfamiliar with these requirements, please seek the advice of legal counsel. )Site:
Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
** Job Summary
** 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.
Essential Functions  
-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.
** Qualifications
* *** Education
* ** High School Diploma or Equivalent required and Associate's Degree preferred
** Experience
* ** At least 1-2 years of experience in healthcare billing, claims management, or third-party liability preferred
** Knowledge, Skills, and Abilities
*** 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.
** Additional Job Details (if applicable)
**** Working Conditions
*** This is a remote role that can be done from most US states
* This is a full-time schedule with a Monday through Friday, 8:00 AM - 4:30 PM EDT schedule
** Remote Type
** Remote
* * Work Location
** 399 Revolution Drive
** Scheduled Weekly Hours
** 40
* * Employee Type
** Regular
* * Work Shift
** Day (United States of America)
** Pay Range**$19.42 - $27.74/Hourly
** Grade
* * 3

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications;

however, it does not encompass all elements contributing to your total…