Medicaid Third Party Liability (TPL) Specialist - Des Moines, IA

Medicaid Third Party Liability (TPL) Specialist - Des Moines, IA

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. As an Medicaid Third Party Liability (TPL) Specialist - Des Moines, IA at Gainwell, you will support healthcare operations by verifying, documenting, and coordinating insurance-related information to drive accurate third-party liability (TPL) recovery efforts. This role focuses on researching and validating insurance coverage, managing correspondence with key stakeholders, and supporting workflows tied to the Iowa Medicaid contract. You will operate in a fast-paced, production- and quality-driven environment while ensuring compliance with established processes and service level agreements.

Your role in our mission

• Research, verify, and document third-party liability (TPL) insurance coverage using multiple systems and data sources
• Initiate and manage correspondence between Revenue Collections, insurance carriers, and the Iowa Department of Health and Human Services
• Conduct outbound calls to insurance carriers to validate coverage and obtain claim-related information
• Process and manage incoming faxes and emails related to TPL insurance verification requests
• Maintain accurate and timely documentation within systems such as MMIS and OnBase
• Identify opportunities to improve workflows and support increased recovery outcomes
• Support project initiatives by compiling, analyzing, and reporting data as needed
• Ensure compliance with departmental standards and contractual Service Level Agreements (SLAs)
• Prepare and deliver periodic reports and updates to leadership
• Perform additional duties as assigned

What we're looking for

• High School Diploma or GED required
• 2+ years of experience with HMS or 3+ years of experience in a professional office environment
• Strong working knowledge of Microsoft Office (Excel, Word, Outlook)
• Strong attention to detail with the ability to manage multiple priorities
• Ability to analyze information and resolve issues using sound judgment
• Effective communication and interpersonal skills

What you should expect in this role

• Hybrid role based in Iowa (within ~2.5 hours of Des Moines)
• Required onsite training in Des Moines upon hire
• Ongoing onsite presence 13 days per week to support deposit activities
• Primarily sedentary work in a professional office environment
• Frequent interaction with internal teams and external stakeholders
• Use of multiple systems, including MMIS and OnBase
• May require extended hours based on business needs
• Up to 10 lbs. occasional lifting
• Video camera must be used during interviews and the first week of orientation
• Minimum internet speed of 24 Mbps download / 8 Mbps upload for hybrid work

The pay range for this position is $24,800.00 - $35,400.00 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.