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Collaborate and maintain cross-functional working relationships with team members of multiple business units; Claims Third-party Administrators (TPA), Programmers, and approved vendors to analyze and correct data quality errors.
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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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Strong understanding of quality assurance and compliance related issues for both direct handled and TPA handled claims service models with a focus on Workers Compensation. A graduate degree preferred (JD, MBA, Other.
$128,500 - $215,000Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Provides outstanding customer service and works well with the insured, broker and TPA in the adjustment of complex and mainstream casualty, specialty risks and business auto claims. Bachelor's degree required, JD preferred.
$80,500 - $137,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Thorough understanding of permitting standards (Including but not limited to TPA, Special Event, Fire, Health & Safety, Building & Safety, Noise, etc.) Dera Lee Productions is an award winning event production and design agency that brings brand campaigns to life through an in-depth understanding of the event industry, theater arts, and marketing trends.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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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.
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Our TPA client is currently seeking a highly skilled and experienced Commercial Property Claims Adjuster to join their Claims Department. Candidate needs to come from a TPA or Insurance Carrier.
Full-timeRemoteExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Experience: Proven track record selling solutions into employers and utilizing the broker/TPA/PBM channels for sales success. Our advisors include executives from Rightway, Optum, and Memorial Sloane Kettering.
$115,000 - $150,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Escalates claim issues to management, BP’s, TPA and legal when needed. Ensure that the TPA is using resources to mitigate exposure (Case Management, surveillance, background checks, prior medical records and findings are clearly documented in file notes.
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Coordinate with the Company’s Worker Compensation Third Party Administrator (TPA) and file necessary Worker Compensation claims. Serve as a gatekeeper of health services, rehabilitation, return-to-work, and case management.
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Detailed review 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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Partner effectively with external sales counterparts and generate monthly sales results within an assigned geographic region in the financial advisor channel and TPA network. The Internal Sales Consultant (ISC) is a member of the Inside Sales organization and is tasked with identifying, developing, and maintaining selling relationships in the broker-dealer community within their assigned territory.
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Quarterbacks all post bind activities including policy production, compliance issues, audits and adjustments, legal agreements, receipt of collateral, legal agreement execution, TPA coordination and any other related items.
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Possess a thorough understanding of all loss sensitive programs including products, pricing, expensing, actuarial loss projecting techniques, retention and aggregate setting, limit profiles, ALAE, and effective utilization of facultative reinsurance.
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Communicating with client for resolution/action (EFT set up, TPA, Applied For, Penalty and Interest report). Demonstrate proficiency in Excel (i.e. pivot tables, vlookup, macro development, etc.
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tpa job Company: Metroplus Health Plan in Sunnyside, NY
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