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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.
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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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Oversee the development of monthly claims reports in partnership with TPA and or financial analyst. Work with location and TPA to ensure effective processes of preservation / collection of all pertinent documentation including videos, recordings, etc.
Full-timeExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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Working under the direction of the Sr. Director, TPA Management and Claims Compliance, the Payment Integrity (PI) Recovery Analyst will assist in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical expense spending and support the execution for a comprehensive claim accuracy program.
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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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Minimum 15 years of experience in Life Insurance and Annuity TPA business involving multiple product lines. Life & Annuity Insurance domain knowledge in a TPA environment. This position is fully Remote/Work from Home and may be based anywhere in the continental United States.
RemoteExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Develop strong working relationships with vendors and third-party administrator (TPA) to ensure accurate, efficient, and timely claims administration and excellent customer service. Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center.
$30.87 - $47.85 an hourFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Responsible for maintaining TPA accumulations and decrements reporting to and collaborating with the 340B Team. Expertise in standards and regulations promulgated by relevant legal and regulatory bodies: Massachusetts Department of Public Health (DPH), Massachusetts Board of Registration in Pharmacy (BORP), The Joint Commission (TJC), Centers for Medicare and Medicaid (CMS), Food and Drug Administration (FDA), and the United States Pharmacopeia (USP.
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Experience in partnering with Legal, TPA and Insurers for effective claims litigation management. 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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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.
Full-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Participation in all aspects of program management such as actuarial pricing, claim or TPA oversight, reinsurance accounting and collateral management. Participation in all aspects of program management such as actuarial pricing, claim or TPA oversight, reinsurance accounting and collateral management.
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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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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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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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This position is responsible for project management of claim closure, early intervention, TPA selection, and claim audit projects. With annual revenue of over $20 billion, Marsh McLennan helps clients navigate an increasingly dynamic and complex environment through four market-leading businesses: Marsh, Guy Carpenter, Mercer, and Oliver Wyman.
Full-timeExpandApply NowActive JobUpdated 28 days ago
tpa job in Woburn, MA
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