Appleton Avenue Teller (Part Time)
+--------------------------------------------------------------------------+ | JOB SUMMARY: | | | | The TPL Specialist is responsible for optimizing TPL recovery efforts by | | identifying and investigating Boston Medical Center HealthNet Plan | | (BMCHP) members who are eligible for coverage with worker’s | | compensation, automobile, or general liability carriers. The TPL | | Specialist is responsible for partnering with our providers and members | | to respond to and resolve incoming COB inquiries and appeals. The TPL | | Specialist is expected to take complete responsibility for every | | interaction with a provider and a member by providing outstanding | | service. The TPL Specialist is responsible for establishing and | | negotiating liens, accurate and timely processing of TPL claims, | | completing activity reports, communicating TPL policies to internal and | | external sources, and supporting the recovery efforts of the department. | | | | | +--------------------------------------------------------------------------+ | KEY FUNCTIONS/RESPONSIBILITIES: | | | | - Responds to provider and member phone calls and correspondence | | including but not limited to claim adjustment requests, appeals, | | corrected claims, timely filings and projects. | | - Investigates member accidents and identifies the liable third party | | carrier through phone calls, review of vendor databases, provider | | inquiries and claims in order to optimize savings to the Plan. | | - Creates and updates liens as appropriate. Negotiates liens with | | attorneys effectively in order to maximize return to the Plan. | | Adheres to all applicable statutory lien requirements. | | - Accurately processes TPL claims in Facets, including retractions, | | denials, repayments and secondary balances. | | - Handles phone calls from Customer Care Center representatives and | | member attorneys. | | - Processes all departmental reports in an accurate and timely manner | | and reports findings to the team lead and manager. | | - Participates in departmental meetings and assists in the development | | of workflow and process improvements. | | - Assists in internal departmental training programs on TPL and | | participates in the training of new TPL team members. | | - Identifies additional methods for increased recoveries through | | interactions with internal and external customers. | | | | | +--------------------------------------------------------------------------+ | QUALIFICATIONS: | | | | EDUCATION: | | | | - Bachelor’s Degree in Business, Healthcare Administration or related | | fields; or an equivalent combination of education, training, and | | experience is required. | | | | EXPERIENCE: | | | | - Four or more years of progressively responsible experience in a | | healthcare or managed care field required. | | - Experience in varied methods of subrogation, TPL claims processing, | | and experience in a Medicaid MCO setting highly preferred. | +--------------------------------------------------------------------------+ | COMPETENCIES, SKILLS, AND ATTRIBUTES: | | | | - Knowledge of MA Comparative Negligence, PIP and Bodily Injury laws. | | - Strong investigative, analytical and negotiation skills. | | - Proficient PC skills including all Microsoft Office | | products required. | | - Candidate must be able to multi-task and prioritize work. Must have | | excellent verbal and written communication skills, organizational | | skills and customer service skills. The TPL Specialist must | | demonstrate initiative for process improvement and have the ability | | to provide direction and feedback to co-workers. | | - Ability to work both as a team member and independently. | | | | | +--------------------------------------------------------------------------+ | *Qualified applicants will receive consideration for employment without | | regard to race, color, religion, sex, national origin, sexual | | orientation, gender identity, disability or protected veteran status. | +--------------------------------------------------------------------------+
Required Skills Required Experience
Physical requirements include: standing, sitting, walking, using hands and fingers, reaching including reaching above the shoulder, talking and hearing: visual acuity; occasional stooping or crouching and occasional lifting a maximum of 50 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.