JOB TITLE: THIRD PARTY LIABILITY SPECIALIST SUPERVISOR

JOB CODE: 39690

SERIES NATURE OF WORK: The Third Party Liability (TPL) Specialist job series describes work in the evaluation and recovery of cash benefits and Medical Assistance (MA) expenditures against liable third parties, insurers, recipients, and probate estates.

DEFINITION: This is professional supervisory work in the evaluation, review, and recoupment of funds related to personal injury and estate recovery claims in the Department of Human Services (DHS).

An employee in this job supervises professional staff responsible for evaluating claims cases, identifying liable third party entities, and recovering cash and MA expenditures from insurance carriers, attorneys, or other third parties. Work involves reviewing and assigning case referrals, advising staff on pursuing claim reimbursements, interpreting and applying federal and state laws and regulations pertaining to MA recovery, and advising TPL staff on new and difficult cases. Work includes managing un-administered estate cases, spousal annuity cases, and other specialty cases; adjusting case assignments to increase productivity; responding to customer inquiries; and collaborating with attorneys and government agencies to ensure program efficiency and accuracy. Work is performed independently under an administrative supervisor and is reviewed through conferences, reports, and results achieved in meeting established goals and objectives.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Supervises TPL staff responsible for evaluating claim cases, identifying liable third party entities, and recovering cash and MA expenditures from insurance carriers, attorneys, or other liable third parties.

• Advises staff on policies, procedures, and legal requirements for personal injury and estate recovery claims.

• Monitors and adjusts staff assignments to improve processing times and balance workloads.

• Serves as a liaison between TPL staff and the Office of General Counsel in cases with multiple legal issues.

• Processes specialty cases involving spousal annuities, immigration, and un-administered estate claims.

• Applies relevant laws, regulations, and policies to maximize cost recovery in personal injury and estate recovery claims.

• Monitors case files to ensure claims are processed accurately and promptly.

• Prepares case reports to support the department’s claims and testifies in court hearings.

• Analyzes program performance reports and identifies areas for improvement.

• Recommends and implements new procedures to streamline processes, improve efficiency, and achieve program goals.

• Updates policy and procedure manuals to maintain accuracy.

• Conducts TPL staff training sessions on new processes and procedures.

• Reviews and prepares correspondence and case documents.

• Performs the full range of supervisory duties.

• An employee in this job may participate in the performance of subordinates’ work consistent with operational and organizational requirements.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES

• Knowledge of the laws, regulations, and statutes related to third party claims administration.

• Knowledge of the methods and practices of insurance claims evaluation and adjustment.

• Knowledge of the procedures and practices for third party liability claim reimbursements.

• Knowledge of the laws and statutes that impact Medical Assistance and estate recovery programs.

• Knowledge of casualty insurance principles, practices, and terminology.

• Knowledge of the use and functionality of Microsoft Office Suite software.

• Ability to analyze and interpret rules, regulations, policies, and procedures.

• Ability to analyze and interpret numerical information.

• Ability to communicate effectively in writing.

• Ability to communicate effectively orally.

• Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• One year of experience as a Third Party Liability Specialist or Third Party Liability Agent (Commonwealth titles);

or

• One year of professional experience collecting, interpreting, or analyzing claims information;

or

• An equivalent combination of experience and training.