Manager, COB / TPL

TPL Manager

The TPL Manager is responsible for leading a highly skilled team in the identification, coordination, and recovery of medical claims expenses from third-party resources. This role ensures compliance with regulatory and contractual requirements, optimizes reimbursement opportunities, and continuously improves operational efficiency. The TPL Manager is directly accountable of staff for the intake, analysis, and reconciliation of third-party resource files and claim reviews to exceed service performance objectives.

Leads and manages the TPL staff, providing guidance, goal setting, support, and professional development as well as performance monitoring and strategic planning.

Evaluates unit activity reports and reviews staff production for completeness, accuracy, and timeliness of claim research and resolution; and assures the timely updating of data into the automated files and systems.

Consolidates validated TPL financial value data from various sources to enable reporting, trend analysis, benchmarking, and forecasting in support of strategic decisions and key performance indicators.

Maintains accurate up-to-date third party liability files and data on eligible membership recipients for entry into computerized system.

Establishes measures to identify and verify third party resources to support cost-avoidance and recovery of funds not the responsibility of JHP, i.e. TPL Flagging.

Ensures the timely and effective handling of claims in accordance with service level agreement requirements.

Develops, implements, and maintains new policies and procedures related to TPL and associated operational processes as needed.

Implement best practices and innovative solutions to enhance TPL programs.

Stays informed about best practices and emerging trends through engagement with external partners such as auditors, regulatory agencies, and industry groups.

Maintains and fosters a collaborative relationship with internal and external customers.

Communicates with Leadership regarding departmental quality improvement initiatives, issues which involve coverage and / or payment policies and provider complaints of significant importance to warrant intervention to correct problems or a change in claim processing procedures.

Analyze standard generated reports and develops ad hoc reports, as needed, to take appropriate actions to reduce errors, suspended or otherwise inappropriately handled claims.

Identifies recovery initiatives through data analysis of TPL data, claims payments, and other payment resource investigation.

Collaborate with Legal, Claims, IT, and external vendors to streamline TPL processes and recovery efforts.

Perform other duties as assigned.

Key Job Requirements :

Education : Bachelor's Degree required or 5-7 years experience in managed care and / or indemnity insurance with a minimum of 3 years in a management position.

Skills / Abilities : Previous claims management experience preferred. Experience in claims processing and regulations. Excellent organizational, interpersonal, time management, and communications skills. Strong conflict resolution skills. Process and project management ability.

Compliance Statement : Compliance with all applicable rules, regulations, and laws is a condition of employment. Employees must read and sign the Code of Conduct and be expected to perform their duties ethically and honestly.

Work Shift : Workday Day (United States of America)

Worker Sub Type : Regular

Employee Entity : Health Partners Plans, Inc.

Primary Location Address : 1101 Market, Philadelphia, Pennsylvania, United States of America