With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential.
Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility .
Responsibilities
Independently manage assigned Third Party Administrator (TPA) relationships
Address and resolve TPA performance issues in coordination with internal partners (Stat Reporting, Finance, Claims Finance, DQ, Claims IT, Underwriting, Claims, Legal)
Collaborate with internal partners to identify and address process gaps or potential efficiencies
Manage day to day issues and inquiries from our TPAs and internal partners
Complete comprehensive due diligence reviews of potential new TPAs
Complete multi-step onboarding process of new TPAs
Participate in projects as requested
Complete annual TPA reviews, PWC testing and other key initiatives for assigned TPAs
Mentor and train new team members
Other duties as assigned
Key Competencies
Strong communication skills, both verbal and written
Ability to effectively prioritize multiple responsibilities
Detail and results-oriented
Team oriented
Ability to problem solve
Required Education and Experience
Bachelor’s degree
Minimum 7 years Insurance Claims experience
Minimum 7 years TPA knowledge
Preferred Technical Skills
Competent with Excel, Word, PDF and PowerPoint
LI-SW1
LI-REMOTE
For individuals assigned or hired to work in California, Colorado, Hawaii, Jersey City, NJ; New York State; and / or Washington State, the base salary range is listed below.
This range is as of the time of posting. Position is incentive eligible.
$79,900 - $107,900 / year
Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs.
The above range may be modified in the future
TPA Management Specialist
A company is looking for a TPA Management Specialist for a remote position. ...
TPA Management Specialist
Complete annual TPA reviews, PWC testing and other key initiatives for assigned TPAs. Independently manage assigned Third Party Administrator (TPA) relationships. Address and resolve TPA performance issues in coordination with internal partners (Stat Reporting, Finance, Claims Finance, DQ, Claims IT...
Medical Claims Specialist - Hamilton, NJ
Medical Claims Specialist - Hamilton, NJ. Resolves pending claims based on Medicaid rules and regulations established for final processing. Price claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures. Good working knowledge of medical c...
Senior Claims Specialist - Construction
Large Complex Builder's Risk claims (retail). Large Complex Builder's Risk claims. Direct management of claims including the investigation, analysis and evaluation of coverage liability and damages, within best practices. Collaborating across disciplines and business units, including: the general co...
Claims Quality Assurance Specialist
A company is looking for a Claims Quality Assurance Specialist responsible for auditing claims processes and supporting quality assurance for claims adjusting teams. ...
RCO-Advanced Claims Review Specialist
As an Advanced Claims Review Specialist, the ideal candidate responsible for workflow - submitting retro rebilling claims to Medicare, Medicaid, and Private Insurances for reimbursement while performing other clerical duties as necessary. We’re looking for an Advanced Claims Review Specialist to joi...
Complex Claims Specialist - Nfp Community Associations
Manages an inventory of moderate to high complexity of Director & Officers claims for Community Associations by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Establishes an...
Sr. Claims Specialist, Healthcare
This position in Healthcare Claims will be responsible for the resolution of moderate to high complexity and moderate to high exposure claims which can be subject to disputes that must be resolved in mediation or litigation. Confirms coverage of claims by reviewing policies and documents submitted i...
Manufacturing Supervisor
QuidelOrtho unites the strengths of Quidel Corporation and Ortho Clinical Diagnostics, creating a world-leading in vitro diagnostics company with award-winning expertise in immunoassay and molecular testing, clinical chemistry and transfusion medicine.We are more than 6,000 strong and do business in...
Allergy-Territory Account Specialist - Columbus, OH - Remote
This is a field-based and remote opportunity supporting the key accounts.Novartis is unable to offer relocation support for this role.Please only apply if this location is accessible for you.The Territory Account Specialist (TAS) is a self-motivated, business leader that crafts a tailored customer e...