MVA/Third Party Liability Resolution Specialist II

Reports To: Insurance Manager / Insurance SupervisorClassification: Non-ExemptPosition DescriptionThe MVA/TPL Resolution Specialist II is an experienced specialist responsible for independently investigating, negotiating, and resolving complex hospital accounts involving Motor Vehicle Accident (MVA) and Third-Party Liability (TPL) claims. The Specialist II manages complex, disputed, escalated, high-dollar, and attorney-represented accounts requiring advanced knowledge of liability claims, insurance coverage, hospital liens, healthcare reimbursement, and settlement resolution. The position works directly with insurance carriers, claims adjusters, attorneys, patients, and other involved parties to maximize client recovery while protecting applicable lien and reimbursement rights. The Specialist II also serves as a subject-matter resource to less experienced team members and supports the continued development of MVA/TPL workflows and best practices.Major Areas of ResponsibilityIndependently manage complex MVA/TPL accounts from initial investigation through final resolution.Analyze registration, diagnosis, accident, insurance, clinical, billing, payment, legal, and account information to determine appropriate recovery strategy.Conduct detailed investigation of accident circumstances, responsible parties, liability status, available coverage, claim numbers, policy-limit concerns, attorney representation, multiple claimants, and other potential sources of reimbursement.Identify and pursue appropriate primary, secondary, and alternative sources of recovery.Evaluate complex hospital lien circumstances and determine appropriate lien actions within applicable requirements and client guidelines.Prepare, submit, document, monitor, and manage hospital liens and related notices.Monitor settlement developments, lien deadlines, documentation requirements, coverage issues, and other critical account milestones.Communicate and negotiate directly with liability insurance carriers, claims adjusters, personal-injury attorneys, patients, and other parties concerning complex account resolution.Evaluate settlement proposals based on account balance, available insurance coverage, liability information, lien position, settlement circumstances, competing claims, and client-approved guidelines.Develop and communicate counteroffers and settlement recommendations.Negotiate appropriate resolutions within assigned authority and escalate matters requiring client or leadership approval.Research and resolve disputed, delayed, underpaid, denied, high-dollar, or otherwise complex MVA/TPL accounts.Analyze unusual account circumstances and independently determine appropriate next steps within established policies and client requirements.Review payments, contractual or negotiated adjustments, account balances, settlement activity, and account disposition to ensure accurate final resolution.Identify accounts presenting financial, compliance, lien, documentation, or recovery risks and escalate when appropriate.Maintain detailed documentation supporting investigations, negotiation activity, settlement decisions, lien actions, and account resolution.Utilize Electronic Health Records (EHR), payer and carrier resources, client systems, legal documentation, and Revco account-management systems to research and resolve assigned accounts.Maintain compliance with HIPAA, applicable regulatory requirements, client requirements, and company policies and procedures.Serve as a resource to Level I Specialists regarding complex accounts, MVA/TPL procedures, lien processes, carrier and attorney interactions, and account-resolution strategies.Assist leadership with training, workflow development, reference materials, templates, and MVA/TPL best practices.Identify trends, recurring recovery barriers, process gaps, and opportunities for improved reimbursement and communicate recommendations to leadership.Support escalated accounts, special projects, client initiatives, and additional assignments as requested by management.