Remote Third-Party Claims & Recovery Specialist

Commonwealth of Pennsylvania; Pennsylvania; Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Free parking

Job summary

The Commonwealth of Pennsylvania's Department of Human Services seeks a Third Party Liability Specialist to review and analyze medical assistance claims, ensuring funds are used properly and recovering overpayments. You will join a team protecting public resources and supporting statewide programs.

The role involves case investigations, legal research, interagency coordination, and settlement negotiations to maximize recoveries, with telework options part-time and a standard 37.5 hour work week

Qualifications

• Four years of technical experience reviewing, collecting, or evaluating information for program eligibility or insurance limits of liability.
• A bachelor’s degree, or an equivalent combination of experience and training.
• Applicants will be considered to have met the educational requirements once they are within 3 months of graduating with a qualifying degree.

Responsibilities

• Claim Review: Assess referrals to determine whether medical assistance benefits were granted in error and identify responsible parties.
• Case Investigation: Conduct investigations of personal injury and estate matters through communication with attorneys, providers, and other agencies.
• Legal Research: Develop knowledge of laws and regulations that apply to cash and medical benefit claims and apply that information to your work.
• Interagency Coordination: Work with other units and external offices to support efficient claim collection processes.
• Settlement Negotiation: Evaluate case factors to negotiate fair settlements using skilled diplomacy to maximize collections.
• Record Management: Maintain accurate case records and review payments to ensure proper crediting.

Job description

The Commonwealth of Pennsylvania's Department of Human Services seeks a Third Party Liability Specialist to review and analyze medical assistance claims, ensuring funds are used properly and recovering overpayments. You will join a team protecting public resources and supporting statewide programs.

The role involves case investigations, legal research, interagency coordination, and settlement negotiations to maximize recoveries, with telework options part-time and a standard 37.5 hour work week