Third Party Liability Specialist II

This position is responsible for the appropriate handling of cases by effectively communicating with employers, claimants, medical providers, attorneys, insurance agents or brokers, and all other involved parties to the claim. This position will be responsible for ensuring all regulatory and organizational requirements are met as well as gather information required to settle a case.Responsibilities:
• Support Horizon Legal staff with cases (ex: Third Party Liability claims, Medical Malpractice claims, Workers Compensation Claims, Class Action Lawsuits, etc.) where Horizon has been impleaded.
• Respond to weekly requests from vendor (ex: Summary Plan Documents, Claim Purge Request, Form 5500, etc.).
• Audit reimbursement reports to resolve issues and create and submit appropriate reports for management review.
• Prepare materials and documentation to assist with internal and external audits as requested.
• Review and update group language documents to include the appropriate reimbursement rights and create training materials to support procedural changes.
• Assist in monitoring and testing system changes to ensure accuracy.
• Mentor junior and temporary staff through coaching and training. Participate in meetings and workgroups as necessary.
• Perform other duties as requested by Management.

Education/Experience:
• High School Diploma/GED required.
• Requires a minimum of four (4) years of experience in claims processing.
• Third Party Liability experience preferred.

Knowledge:
• Knowledge of Subrogation/Workers Compensation Regulations and Laws preferred
• Strong knowledge of medical terminology required

Skills and Abilities:
• Requires strong computer and reporting skills
• Requires strong analytical and problem solving skills
• Requires strong verbal and written communication skills
• Requires multitasking, follow up, and time management skills
• Requires strong interpersonal skills and the ability to mentor junior staff
• Requires conflict and relationship management skills

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