Third Party Liability Representative

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
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.

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 full-time schedule with a Monday through Friday, 8:00 AM - 4:30 PM ET schedule
- This position is eligible for remote work from approved U.S. locations, subject to organizational requirements
- Remote employees must maintain a stable internet connection and a secure, private, quiet workspace appropriate for handling confidential and protected health information
- Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy

Remote Type
Remote

Work Location
399 Revolution Drive

Scheduled Weekly Hours
40

Employee Type
Regular

Work Shift
Day (United States of America)

Pay Range
$19.81 - $28.30/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 compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:
8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.