Third Party Liability Analyst - US Remote

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

The Third-Party Liability (TPL) department's primary function is to pursue and investigate cost avoidance and cost recovery opportunities. The TPL analyst will review leads provided by various resources to make a determination on members' access to primary insurance coverage which would be used prior to their Kansas Medical Assistance Program (KMAP) coverage. The TPL analyst will also review applications for the Health Insurance Premium Payment (HIPP) program, facilitate the monthly Desktop Review audit and process medical subrogation leads. Work assignments include claim research, reports, legal documentation reviews, and corresponding with carriers, vendors, employers, and the State client.

Your role in our mission

• You will assist in providing cost savings to the Client by researching and updating other health insurance plans. This is accomplished by verifying plan information via calls to insurance carriers or by utilizing online verification portals.
• You will respond to requests from the Client, State agencies, Federal agencies, providers, members and representatives within the Company.
• You will research and work claims that require research for reasons relating to other insurances.
• You will assist in claims auditing to ensure that providers have properly billed third party payers.
• You will work with a team to ensure that all daily work is performed within service level agreements.

What we're looking for

• A candidate must be able to independently manage workload with minimal supervision.
• A candidate must be able to multi-task various work duties.
• A candidate must be able to compose professional responses to inquiries.
• A candidate must be able to cross train against different functions on the TPL team.
• A candidate must be able to quicky and accurately enter data into spreadsheets, documents, and the State system.

What you should expect in this role

• Working and training remotely, with minimal supervision after the training period.
• Learning the various commercial plan types, and how to verify them with insurance carriers.
• A steady, fast paced workload that often requires switching tasks as the workflow progresses.
• Candidate must have stable internet service, as well as be prepared for a return to office if necessary.
• Only considering candidates resididing in KS at this time.

#LI-REMOTE #LI-SA1

The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.