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General Description: Manages medical aspects of workers compensation and disability claims for Third Party Administration (TPA) accounts by coordinating with patients, physicians, other health care providers and employers to facilitate positive patient outcomes, timely return to work if applicable and efficient claims resolution.
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Foster ongoing carrier and TPA relationships and provide vendor procurement, negotiation, and optimization. Serve as senior employee benefits consultant and strategist for clients, managing client engagements, expanding existing relationships and developing new business in accordance with approved business plan.
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Help build infrastructure- Collaborate with Operations and Legal Departments to develop operational and compliance standardsCollaborate with Actuarial to develop pricing and monitor profitabilityCollaborate with Legal on contracts and policy forms and endorsementsCollaborate with Claims on TPA agreements and relationships Work directly with Program Administrators and TPAs on assigned programs.
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TPA certified/Legend Drug Certificate. HealthDrive delivers on-site optometry, dentistry, podiatry, audiology, and behavioral health services to residents in long-term care, skilled nursing and assisted living facilities.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The company’s expert adjusters have an average of over 20 years’ experience, operating across a range of industries with specialties including: Property, Casualty, Crisis Management, Natural Resources, Construction & Engineering, Agriculture, Aviation, Forensic Accounting, Investigation, Marine, FAJ & Specie, Global TPA Services and Environmental consulting services.
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Experience in partnering with Legal, TPA and Insurers for effective claims litigation management. Oversee the development of monthly claims reports in partnership with TPA and or financial analyst.
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Work with location and TPA to ensure effective processes of preservation / collection of all pertinent documentation including videos, recordings, etc. Review claim reports and determine defense/development and provide feedback to TPA to develop strategy for resolution taking accident/event severity; known facts and venue.
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Review reserve needs with TPA for appropriateness, presenting changes to the Reserve Committee with justification ensuring approvals in line with delegation of authority. Meet monthly with TPA for program status, needs, trends, action plan updates.
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Utilize TPA audit findings to develop process improvement strategies and action plans. Partner with TPA to evaluate and develop strategies for prompt resolution. Environmental commitment: Keolis is committed to protecting the environment by minimizing the impact of operations to our people and the communities in which we operate.
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We provide a comprehensive line of service offerings including commercial property, casualty, inland marine/cargo, heavy equipment and large loss adjusting, as well as TPA/claims management and subrogation.
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Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, claims operations, prior authorization, appeals, program integrity and reporting related to the AFC/GAFC programs, and ability to triage issues to the appropriate OLTSS internal staff.
$107,580.72 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Your onboarding will not only enhance Neuroscience nursing but develop specialized skills and prepare you to care for our intermediate care level of patients that require a higher level of monitoring, post-thrombectomy and TPA patients, caring for external ventriculostomy drains and the initiation of some vasoactive infusions.
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Supporting the Commonwealth of Massachusetts, the MALTSS TPA program manages several elements of MassHealth’s LTSS program, including prior authorization, provider enrollment and credentialing, program integrity, and quality improvement.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Develop and maintain TPA, carrier and reinsurance relationships. Maintain deep regulatory knowledge including ERISA, COBRA, HIPAA, FMLA, ADA, state and municipal leave laws, and healthcare reform.
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tpa job in Boston, MA
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