TPL Claims Representative

About the role

Elevate Patient Financial Solutions is seeking a detail-oriented and proactive professional 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).

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.
• Cookordinate 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.
• Avoid 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.
• Other duties as assigned.

Qualifications and Requirements

• A 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.

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

Company Information

• Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

Company Culture

• 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.
• We believe in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset!

Equal Opportunity Employer

ElevatePFS is an Equal Opportunity Employer.