Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
The Healthcare Insurance TPL Specialist will work as part of the TPL (Third Party Liability) Operations Team and receive training on the execution of processes and procedures within any/all functional areas. Under general supervision, receive and answer incoming telephone inquiries from providers related to third-party liability with the Medicaid program including member eligibility, claims, adjustments, and recovery of funds related to the delivery of Medicaid or health services. Research and interpretation of federal rules and procedures and agency rule about Third-Party Liability (TPL) and the OK Medicaid program and policies. The research analyzes and resolves provider claim issues related to the TPL department as identified in multiple types of inquiries. to care issues, complaints, e-mails, written correspondence, and telephone calls. Analyze, research, and investigate technically difficult claims. Initiates action to correct erroneous payments, recover third-party liability or other funds, or make final disposition of a claim for payment.
Your role in our mission
Help create the power in Gainwell’s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.
- Uses multiple applications to respond to phone calls and written inquiries from medical providers, HMOs, recipients, court and county clerks, attorneys, and third-party administrators on medical-related issues.
- Assists in training providers and others on Finance issues, especially remittance advice statements, submission of claims, and the recoupment process. Under direction, initiates action to process recoupment of funds from a Medicaid or other health provider.
- Arranges for reimbursement to the agency payments made on behalf of a client, which were made erroneously, or which should have been paid by a third-party payor, e.g., Worker’s Compensation, health insurance, casualty insurance, Medicare, etc.
What we’re looking for
- Call center experience a plus
- Previous medical experience is not required but is a plus
- Experience with Third Party Liability a plus
- Basic computer use skills
- Ability to multi-task across multiple claims to work efficiently
What you should expect in this role
- Initiates contact with claimants, third-party administrators, clients, or other agents to solicit information, correct errors, or omissions on claim forms, and investigate questionable data.
- Other duties as assigned by TPL supervisors. Including but not limited to receiving training on-call help desk functions and procedures, execution of processes and procedures from providers related to third-party liability with the Medicaid program and attending meetings with agency personnel and other officials.
- #LI-HYBRID #LI-JW1
The pay range for this position is $32,700.00 – $46,700.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.