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This position has a direct influence upon both the financial condition of the organization and its’ reputation as a TPA (Third Party Administrator). Performs a spectrum of clerical chores that culminate in determinations for payment of claims to providers for authorized services rendered; specifically for HMO patients, encounter claims from PCP’s or capitated specialists, ancillary claims, emergency room, shared risk, anesthesia, eye exams claims, and Clinic specialty claims.
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Direct experience working with health insurance payers and Third-Party Administrators (TPA). Clarity Performance Solutions solves the most challenging problems for payers and TPAs. With the right mix of human touch and hi-tech, Clarity meets healthcare ops head-on with claims adjudication services, robotic processing automation, auditing and analytics, contact center management, staffing, omnichannel engagement, and strategic consulting services.
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Manage claims in conjunction with contracted Third Party Administrators (TPA) Provides outstanding customer service and works well with the insured, broker/MGA/TPA during the adjustment of claims.
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HealthComp is a leading third-party administrator (TPA) that specializes in providing customized, full-service healthcare solutions. HealthComp is a leading third-party administrator (TPA) that specializes in providing customized, full-service healthcare solutions.
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Acts as the department s key liaison to all workers' compensation partners including the third party administrator, broker, Human Resources, and hospital department directors/supervisors. Responsible for managing claims in Agility and ensuring all proper documentation is scanned to employee charts; reviews, updates and distributes weekly claims review logs to TPA, clinicians, Directors and senior leadership as directed.
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Conducts research and provides advice and counsel directly to client departments and Third-Party Administrator (TPA). Works closely with Workers' Compensation Department and the Authority's TPA to handle claims in the best interest of the Authority.
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Assisting with maintenance of SIU, Fraud reporting and other Compliance reporting and procedures as these may be required, monitoring, summarizing, tracking compliance objectives and timelines in partnership with a third-party vendor, reporting to internal stakeholders.
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Reliance Matrix delivers employee benefits, absence management and workforce productivity solutions through the financial stability of a top-rated insurance carrier, the agility and innovative spirit of a Third Party Administrator (TPA), and the daily commitment of thousands of team members across America.
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Reviews, analyzes, and makes recommendations regarding workers' compensation cases and/or employee benefits issues; may correspond directly with the employee, with the Department of Human Resources, or with the third-party administrator (TPA.
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Makes regular site visits to non-office locations (e.g., court and CTA field locations) Juris Doctor (J.D.) degree from an accredited school of law and licensed to practice law in the State of Illinois, plus three (3) years of experience as a practicing attorney, of which one (1) year of experience was spent specializing in workers' compensation claims, or an equivalent combination of education and experience.
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Assist in the administration of company leave of absence policies coordinated with an outsourced and centralized leave administration Third Party Administrator (TPA). Designation as Certified Compensation Professional (CCP), Professional in Human Resources (PHR), Senior Professional in Human Resources (SPHR), or Certified Employee Benefits Specialist (CEBS) preferred.
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Our ideal candidate would be a Defined Contributions Compliance Consultant with a Bachelor's Degree, and with a current, active designation as a Qualified 401(k) Administrator (QKA), Qualified 401(k) Consultant (QKC) designation from American Society of Pension Professionals and Actuaries (ASPPA), has worked a minimum of five (5) years' experience as a compliance consultant, and experience working at a Third Party Administrator (TPA.
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Minimum FIVE (5) years of experience working as a Compliance Consultant or closely related capacity at a Third Party Administrator (TPA), Track jobs in the Retirement Plan Administrator system (RPA) to ensure timely completion.
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Advanced Compliance Testing, including ADP/ACP, Coverage, and Non-discrimination testing, with a focus on accuracy and corrective actions when necessary. Handling corrective contributions and distributions, including filings for VCP and SCP.
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Offer consulting expertise on matters concerning IRS and ERISA compliance, providing insightful guidance to clients to navigate regulatory requirements effectively, Review annual valuations for accuracy, prepared either by ghost consultants, team members, or peers.
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