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Follow the status of workers' compensation claims with a third-party administrator (TPA); serve as liaison with departments, legal counsel, and the TPA; make recommendations for settlement; and coordinate return to work and modified duty programs.
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Experience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) - The Manager, Credentialing Operations collaborates with Provider Data Management (PDM), Market Operations, Shared Service team, and our external business partners to monitor operations, resolve service barriers, develop solutions to improve effectiveness, and identify continuous improvement initiatives to increase service and operational level agreements.
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Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System and proprietary claim systems.
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ABI Document Support Services is the largest nationwide provider of records retrieval, subpoena services, and document management for the legal and insurance industries. Eventually candidates will provide presentations to decision makers and key influencers regionally for mid-level carrier and TPA accounts as needed.
Full-timeRemoteExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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As a key member of the Aroris Operations team, the Payer Relations Manager is responsible for maintaining strong relationships and smart negotiations with payers, supporting payer-provider negotiation strategy, and supporting the client success manager in ensuring strong client relationships.
$45,000 - $65,000 a yearFull-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Penrose - St. Francis Health Services is a full-service, 712-bed acute care provider in Colorado Springs comprised of Penrose Hospital, St. Francis Hospital and St. Francis Hospital - Interquest.
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This position is also responsible for assisting in the development of relationships with our strategic clients, which could lead to supporting and implementing TPA and mid-level carrier opportunities in their region.
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Is the largest nationwide provider of records retrieval, subpoena services, and document management for the legal and insurance industries. is the largest nationwide provider of records retrieval, subpoena services, and document management for the legal and insurance industries.
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Knowledge of SQL. Experience working in a data warehouse environment (Artemis Health, Cotiviti, SCIO, Springbuk or any carrier/TPA platforms). We’d love to meet you if your professional track record includes these skills: Minimum 5 years of employee benefits and or/healthcare experience with benefits consultant, broker, health plan, health system or provider group.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Building an enhanced Quality Program for Liability Claims inclusive of Third Party Administrator (TPA) Performance. Safety National is a leading specialty insurance and reinsurance provider.
$94,000 - $151,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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This teammate will be responsible for building, scaling, and continuously improving our PACE Health Plan Operations function, which includes, but is not limited to, TPA management/oversight (claims), utilization management, provider network administration, and more.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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LI-Hybrid About Us 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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Assists TPA with provider compensation configuration by creating and testing compensation grids used for reimbursement and claims processing. Reviews and investigates claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations.
ExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Carrier is the leading global provider of healthy, safe and sustainable building and cold chain solutions with a world-class, diverse workforce with business segments covering HVAC, refrigeration, and fire and security.
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Serve as the department's liaison with TPA regarding regulatory information such as proposed and final Medicare Advantage and/or Medicaid payment regulations and Medicare Advantage manual updates related to coding/billing changes.
ExpandApply NowActive JobUpdated 3 months ago
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