TPL Claims Representative

Elevate Patient Financial Solutions®; United States; Remote; USD 40,000 - 60,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

401K (100% match for the first 3% & 50

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 #

Job summary

Elevate Patient Financial Solutions is seeking a detail-oriented Third Party Liability (TPL) Representative to resolve auto, home, and other liability claims. The role follows a Monday–Friday 8 AM–5 PM schedule with remote work options, supporting our hospital and patient partners in coordinating benefits and pursuing reimbursements.

You will investigate claims, coordinate with payors, and ensure proper filing guidelines are met, while maintaining timely updates and accurate documentation across

Qualifications

• High School Diploma or GED required or preferred by client
• 1-2 years computer experience including internet and MS Office, ability to learn in-house apps
• 1-3 years related experience in field
• Strong verbal and written communication skills
• Knowledge of third-party claims adjudication process
• Knowledge of state lien statutes, CMS secondary payer rules, and No-Fault laws
• Remote/Hybrid roles require home internet meeting speed criteria

Responsibilities

• Resolve accounts quickly and accurately to maximize reimbursement
• Review and research accident claims to identify leads
• Bill no-fault and third-party liability carriers when appropriate
• Request documentation from insurance representatives when no no-fault exists
• Coordinate with payors to ensure filing guidelines for reimbursement
• Contact insurance professionals, patients, and other parties to verify data
• Appeal underpayments and pursue reimbursements as needed
• Maintain timely attendance and complete other duties as assigned

Skills

Effective verbal & written comms

No-Fault laws knowledge

CMS secondary payer rules knowledge

Third-party claims adjudication

Education

High School Diploma or GED

Job description

Elevate Patient Financial Solutions is seeking detail-oriented and proactive professionals 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). If you're passionate about making a meaningful impact and growing your career in a purpose-driven environment, this is your opportunity to shine!

TPL Representatives are healthcare heroes in a different way - by resolving TPL claims for patients and the hospitals who care for them

In this role, you will be responsible to responsible for investigating, facilitating, and coordinating 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.
• 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.

Qualifications And Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

• 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.

Benefits:

ElevatePFS 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.

• 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

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

ElevatePFS is an Equal Opportunity Employer