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Overall, the role will focus on the following areas: Self-funded market (MSO/TPA), fully-insured market, maintain a presence with existing City Agency and Daycare business (for Gold and GoldCare) and the Individual Coverage Health Reimbursement Arrangement (ICHRA) Market.
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Manage the company's Captive Insurance Program; Adjusting WC and GL Claims. and this person will be responsible for utilizing their expertise in the construction industry to handle insurance procurement, collection of certificates of insurance from subcontractors and vendors, reviewing insurance terms and conditions for subcontractor agreements and owner agreements, and handling workers' compensation claims and insurance claims for the company.
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Medicare or Medicare Advantage payment integrity or claims operations experience; preferred. Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
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Collaborating across disciplines and business units, including: the office of general counsel overseeing errors & omissions issues arising from claims handling, the Brandywine (run-off) team, the Bermuda claims team and in-house coverage counsel team.
$128,500 - $215,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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In this role, the successful candidate As part of the Pharmacy Business & Analytics (PBA) team, this position monitors and manages Third Party Administrator (TPA) split-billing software reports to ensure regulatory compliance and optimization of 340B Program revenue.
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The attendi ng physician w i ll perform dut i es of a fu ll-t i me rad i ation oncologist i n our department, i n clud ing but not limited t o seeing new ou tpa t ient and inpatient consu lt s and follo w ups , developing and v i ewing radiat i o n plans , perform ing on treatment visits, and participating i n departmenta l and hosp i ta l meetings includ i ng quality assurance, tumor boards and ca n cer comm itt ee.
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Partner with and collaborate across functions on analytics and strategic initiatives, including, but not limited to, Underwriting, Actuarial, Reinsurance, Claims, and Operations. Experience with and exposure to various operational disciplines (underwriting, claims, IT, etc.
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Primary Responsibilities include:TPAs Fundraising Events & InitiativesWork in partnership with the Managing Director, Development & The Pink Agenda to plan and execute The Pink Agendas annual galas, educational symposiums (TPA Talks), local to NY and chapter city friendraisers, and third-party fundraising events.
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Donor and/or surrogacy claims processing experience is a plus. Kindbody is a leading fertility clinic network and global family-building benefits provider for employers offering the full-spectrum of reproductive care from preconception to postpartum through menopause.
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Understand medical billing, coding, insurance claims processing, and revenue cycle management. Review and process complex claims related to Maven's fertility treatments, procedures and applicable medications, and expenses related to additional paths to parenthood in accordance with company policies and benefits plan designs.
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Overview: Gallagher Bassett is the premier provider of global claims, loss control, and risk management consulting services, dedicated to exceptional customer service and demonstrably superior outcomes.
$100 - $125 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The team deploys the firm's capital for proprietary investment strategies and facilitates client transactions, investing in a broad array of products including corporate bonds, corporate loans, trade claims, post-reorg equities, litigation claims, structured products and public equities.
$100,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Review and oversight of quarterly fund closes based on data received from the Third Party Administrator (TPA), which includes review of related support for all balance sheet and income statement accounts.
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In addition, the AVP, Claims Counsel supports the Underwriters/Actuaries on any claims related interactions with cedents and brokers. The AVP, Senior Claims Analyst is responsible for, but not limited to analysing, and processing claims under the applicable reinsurance treaty, performing claims audits, providing analysis to underwriters and reserving actuaries, and participate in collaborative projects in support of other areas of the company, including finance, actuarial, operations and technology.
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AVP Claims - Allied Healthcare & MPL page is loaded. AVP Claims - Allied Healthcare & MPL. Expert knowledge of claims handling practices to include: coverage analysis, litigation management and negotiation.
$145,000 - $170,000Full-timeExpandApply NowActive JobUpdated 2 days ago
claims tpa jobs Company: Metroplus Health Plan in Sunnyside, NY
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