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TPL Claims Representative

Elevate Patient Financial Solutions
Remote, USA
Full-time
Entry · 1+ years experience
Remote
Discovered 1 months ago
Microsoft Office Suite

Full Job Posting

  • 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.
  • 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.

• 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

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