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TPL Claims Representative
- Job ID
About The Company
At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.
MedData has an excellent career opportunity available as a Claims Rep- Third Party Liability (TPL) to work in an office setting located in The Woodlands, TX. The schedule for this FT role is Monday - Friday 8am - 5pm
The purpose of this position is to investigate, facilitate and coordinate 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. Requests 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
- Secure documentation from medical providers, insurance companies, police departments, and patients, and accurately update pending liability cases with new information obtained from the documents
- Obtain bills and medical records from medical providers and send them to insurance companies for processing.
- Verify information obtained from patients and medical providers regarding insurance coverage with insurance companies for accuracy
- Assist patients in the filing of first party claims
- Administer hospital liens for third party liability claims
- Administer liens in compliance with state lien statute parameters regarding lien format, content, and notification requirements
QUALIFICATIONS AND REQUIREMENTS
- High School Diploma or GED
- Thorough knowledge of the liability claims adjudication process
- Ability to communicate effectively verbally and in writing
- Proven ability to be assertive in order to proactively resolve issues
- 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
MedData 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.
Just some of the benefits we offer:
- HSA, FSA
- Paid Time Off and 7 Paid Holidays
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please apply directly to this posting.
MedData is an Equal Opportunity Employer