Site: Mass General Brigham Health Plan Holding Company, Inc.
Responsible for managing the Coordination of Benefits and Third Party Liability organizations. Oversee the process of recovering funds from other health insurance plans and liable third parties for claim-related expenses and ensuring compliance with relevant laws and regulations. Lead the identification of responsible parties, evaluation of claims, and manage the end-to-end recovery process, often working with insurance companies, attorneys, and other stakeholders. This role also involves supervising staff, developing and implementing strategies to optimize cost recovery, and maintaining accurate records while ensuring that all recovery efforts are conducted in compliance with the organization's policies and regulatory requirements.
Essential Functions
-Oversee the Coordination of Benefits and Third Party Liability processes for recovering funds related to COB and TPL claims.
-Develop and implement strategies to maximize recovery rates and minimize revenue loss.
-Manage, mentor, and train the Recoveries Team to ensure efficient and effective handling of accounts.
-Conduct performance evaluations, provide feedback, and support professional development for team members.
-Review and analyze denied claims and billing issues to determine the root cause and appropriate course of action.
QualificationsEducation- Bachelor's Degree required; experience can be considered in lieu of a degree
Experience- At least 5-7 years of experience in COB, TPL, and claims adjudication experience required
- At least 2-3 years of experience in a supervisory or leadership role required
- At least 2-3 years of experience within a health plan setting preferred
Knowledge, Skills, and Abilities- Strong knowledge of health insurance claims, coordination of benefits, and third-party liability.
- Excellent leadership, organizational, and team management skills.
- Proficiency in using health plan software and tools.
- Strong analytical and problem-solving skills with attention to detail.
- Effective communication and interpersonal skills.
Additional Job Details (if applicable)Remote TypeHybrid
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$99,465.60 - $144,643.20/Annual
Grade8
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
