Third Party Liability 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 POSITION

The Third Party Liability Specialist role with the Department of Human Services gives you the chance to drive real change across Pennsylvania. You join a team that protects public resources and strengthens the fairness of medical assistance programs. This position helps you build valuable skills while taking on important challenges that keep statewide services strong. Step into a role where your efforts make a clear and lasting impact for communities throughout the Commonwealth.

THE POSITION

The Third Party Liability Specialist role with the Department of Human Services gives you the chance to drive real change across Pennsylvania. You join a team that protects public resources and strengthens the fairness of medical assistance programs. This position helps you build valuable skills while taking on important challenges that keep statewide services strong. Step into a role where your efforts make a clear and lasting impact for communities throughout the Commonwealth.

DESCRIPTION OF WORK

This position focuses on reviewing and analyzing claims to ensure that medical assistance funds were used appropriately. You support the integrity of statewide recovery efforts by investigating cases and coordinating with many partners. As a Third Party Liability Specialist, you will perform the following duties:

• 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

Interested in learning more? Additional details regarding this position can be found in the position description .

Work Schedule and Additional Information

• Full-time employment, 37.5 hours per week
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Free parking
• Telework: You may have the opportunity to work from home (telework) part-time, up to three days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• Salary:In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

Minimum Experience and Training Requirements

• Four years of technical experience collecting, reviewing, or evaluating information for program eligibility or insurance limits of liability; or
• 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.

Other Requirements

• You must meet the PA residency requirement . For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

Veterans

• Pennsylvania law (51 Pa. C.S.
• 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

Telecommunications Relay Service (TRS)

• 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

EXAMINATION INFORMATION

1. Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
2. Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
3. Your score is valid for this specific posting only.
4. You must provide complete and accurate information or:
   • your score may be lower than deserved.
   • you may be disqualified.
5. You may only apply/test once for this posting.
6. Your results will be provided via email.