Third Party Liability Supervisor

Job description          

Responsible for overseeing the operation of the Third Party Liability team. Provides performance management and employee development, manages the workflow and productivity of the department including and not limited to optimizing TPL recovery efforts, processing and resolving complex TPL claims, and any related subrogation activity. Implements and develops departmental policies, procedures and service standards. Supports the Manager in day to day operations and focused initiatives. Maintains compliance with state and federal requirements and regulations. Serves as a liaison for internal and external stakeholders as it relates to Third Party Liability.
Key Functions/Responsibilities: Supervise all activities of the Third Party Liability Staff. Monitors and evaluates the quality, timeliness and accuracy of department process including and not limited to TPL claims, appeals, phone calls, lien initiation, updates, negotiations and TPL recovery efforts. Monitors and evaluates metrics and quality reports, establishes departmental goals and performance standards and develops action plans in conjunction with HR. Maintains in-depth knowledge of all BMCHP and Well Sense Health Plan benefits, provider network development, and contract and configuration issues. Facilitates relationships with internal and external stakeholders in the planning, development and coordination of department specific and cross- functional initiatives. Ensures and adheres to MCO Third Party Liability best business practice in accordance with state and federal laws and statues. Participates in staff hiring, work allocation and scheduling, training and professional development, performance management and related supervisory activities.
Qualifications: Education: Bachelor’s degree in HealthCare Administration, Business related field, or equivalent combination of education training and experience is required. Experience: 6 or more years in experience in a managed care, healthcare or managed care setting is required. A minimum of 3 years in a leadership role or equivalent training, mentoring or directing others. Experience working in a Managed Care Organization or Health Care Industry is desired. Competencies, Skills, and Attributes: Detailed knowledge of MA Comparative Negligence, PIP and Bodily Injury Laws and NH TPL Statues and Regulations. Detailed knowledge of MCO payment methodologies and TPL industry standard practices. Strong investigative and analytic and negotiation skills. Strong working knowledge of Microsoft Office products including Word, Excel, Power Point, and Outlook required. Proficiency in the use of system application OnBase, and Facets Claim Processing system. Excellent communication and interpersonal skills with the ability to lead others. Ability to meet deadlines, multitask and use appropriate judgement to solve date to day issues. Detailed oriented with effective problem solving skills. Ability to adapt with complex changes with the industry. Proven history of excellent customer service outcomes. Ability to train and coach subordinates staff required with the ability to lead and direct others. Working Conditions and Physical Effort: Occasional regional travel is required.
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
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BMC HealthNet Plan Massachusetts jobs

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