TPL Claims Representative

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 to 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 gathering 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 and Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

• 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:

ElevatePFS believes in making a positive impact not only within our industry but also with our employees -the organization's greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

• 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

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

ElevatePFS is an Equal Opportunity Employer