Medicaid Third Party Liability; TPL Specialist - Des Moines, IA

Summary

As a 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 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.

• 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 On Base
• 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

• 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

• Hybrid role based in Iowa (within ~2.5 hours of Des Moines)
• Required onsite training in Des Moines upon hire
• Ongoing onsite presence 1–3 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 On Base
• 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

#LI-HYBRID #LI-JA1 #LI-CM1

The pay range for this position is $24,800.00–$35,400.00 per year; base pay may vary by geographic region, internal equity, job‑related knowledge, skills, and experience.

All salaried, full‑time candidates are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, educational assistance, and a variety of leadership and technical development academies.

Gainwell Technologies is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, veteran status, disability status, or other legally protected characteristics. Gainwell defines “wages” and “wage rates” to include all forms of pay, including salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.