[Hiring] TPL Claims Representative @Elevate Patient Financial Solutions

Role Description

Elevate Patient Financial Solutions is seeking detail-oriented and proactive professionals to join our team as a Third Party Liability (TPL) Representative. This full-time opportunity offers a consistent schedule of Monday-Friday 8AM-5PM (remote). If you're passionate about making a meaningful impact and growing your career in a purpose-driven environment, this is your opportunity to shine!

TPL Representatives are healthcare heroes in a different way - by resolving TPL claims for patients and the hospitals who care for them. In this role, you will be responsible for:

• Investigating, facilitating, and coordinating benefits for accident claims from auto, home, or other liability insurance policies.

Essential Duties and Responsibilities:

• Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement.
• Review and research accident claims to investigate possible leads.
• Bill no-fault and third-party liability carriers when appropriate.
• Request documentation from insurance representatives when no no-fault insurance exists.
• Review and research insurance claims to determine possible payment sources.
• Contact various sources including insurance professionals, patients, and other parties to verify relevant data.
• Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement.
• Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.
• Maintain and update payors on denied claims.
• Ensure that appropriate billing guidelines and standards are met based on payor and/or state.
• Make written or verbal appeals to payers on denied claims.
• Obtain claim status and gather supporting documentation to submit appeals.
• Evaluate liability cases according to a multitude of factors, including accident type, patient involvement, patient degree of fault, and available insurance coverage.
• Make accurate determination of the correct course of action to resolve liability cases based on the above data.
• Pursue first party payers for reimbursement of hospital claims.
• Assess state No-Fault laws to determine the availability and extent of first party coverage, and inform uncooperative patients about the proper coordination of available insurance benefits.
• Appeal underpayments made for any reason other than exhaustion of benefits.
• Resolve bodily injury liability claims by asserting and enforcing liens against the liable insurance company.
• Ensure timely and equitable disbursement of settlement funds.
• Regular and timely attendance.
• Other duties as assigned.

Qualifications

• High School Diploma or GED is preferred except where required by the client.
• 1-2 years working knowledge of computer functions including the internet and computer software such as Microsoft Office Suite and the ability to learn in-house computer applications.
• 1-3 years of related experience in the field or in a related area.
• Ability to communicate effectively verbally and in writing.
• Thorough knowledge of the third-party claims adjudication process.
• Thorough knowledge of state lien statutes, CMS secondary payer rules, and state No-Fault laws.
• Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

Benefits

• Medical, Dental & Vision Insurance.
• 401K (100% match for the first 3% & 50% match for the next 2%).
• 15 days of PTO.
• 7 paid Holidays.
• 2 Floating holidays.
• 1 Elevate Day (floating holiday).
• Pet Insurance.
• Employee referral bonus program.
• Teamwork: We believe in teamwork and having fun together.
• Career Growth: Gain great experience to promote to higher roles.