Auto TPA Manager
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Job Location:
Morristown, NJ - USA
Monthly Salary:
Not Disclosed
Posted on:
15 hours ago
Vacancies:
1 Vacancy
Job Summary
At Coaction were a unique mix of leaders achievers thinkers and team players with a high-performance mindset and a diverse skillset. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients.
The Co/Action TPA Manager plays a critical role in ensuring that our outsourced claim administration operates efficiently cost-effectively and in compliance with all relevant regulations. Effective claim oversight requires strong technical expertise project management communication and problem-solving skills as well as a deep understanding of the specific services being outsourced.
The Co/Action TPA Manager is responsible for overseeing the performance of our panel of third-party administrators. Each TPA manager has responsibility for one or more TPAs. Oversight includes day-to-day claims management review of claims for reserve and settlement authority above TPA delegated authority assurance of regulatory compliance compliance with our service agreements and claim handling guidelines meeting of our performance standards delivering quality services and providing exceptional customer experience. Primary responsibilities of the TPA Manager include the following:
1.TPA Management and Relationship Building
Develop and maintain relationships with assigned third-party administrators (TPAs) to ensure smooth collaboration and service delivery.
Serve as the primary point of contact between Co/Action and the TPAs.
Work with AVP of TPA Management and Legal to negotiate new contracts and amendments for renewals and service level agreements (SLAs) with TPAs to establish clear expectations and performance metrics.
Monitor TPA compliance with contract terms regulations and internal policies.
2.Performance Monitoring and Reporting
Track and evaluate TPA performance against established metrics such as claims processing time (durations) customer service response times and cost control.
Analyze reports generated by TPAs such as loss runs financial data and service level performance.
Identify and address any performance gaps or service issues and work with the TPA to implement corrective actions.
Regularly report on TPA performance to AVP highlighting key issues trends and improvements.
3.Risk Management and Compliance
Ensure that TPAs are following all relevant legal regulatory and industry standards such as Medicare Reporting.
Conduct regular claim audits of TPA activities and documentation to ensure that they are adhering to best practices contractual obligations and regulatory requirements.
Monitor the security and privacy of sensitive data handled by TPAs ensuring they meet required standards for data protection.
4.Process Improvement and Efficiency
Collaborate with TPAs to identify process improvements that can enhance efficiency reduce Co/Action costs or improve service delivery.
Support the implementation of any new technologies systems or processes that improve the effectiveness of TPA operations.
Drive continuous improvement initiatives.
5.Claims Oversight
Oversee the TPA claims management process ensuring that claims are processed accurately timely and in accordance with guidelines.
Work with TPAs to resolve disputes or escalated issues related to claims response times or staffing.
6.Training and Support
Provide and/or support training to TPA employees on Co/Action processes policies and expectations (i.e. Subrogation and Recovery SIU and Fraud Medicare).
Offer ongoing support to TPAs as they handle day-to-day claim handling troubleshooting any issues that arise and offering guidance as needed.
Stay updated on industry trends and educate TPAs on any new regulations technologies or best practices.
7.Budget and Cost Management
On a monthly basis review service fee and loss fund invoices from TPAs ensuring that services rendered are in line with the terms of the contract and budget.
Identify opportunities for cost savings and raise these opportunities for possible renegotiation of terms to maximize the value of third-party services.
8.Escalation and Issue Resolution
Resolve complex issues that may arise between Co/Action and assigned TPAs including conflicts or discrepancies in service delivery.
Implement effective strategies for escalation and issue resolution ensuring timely resolution of problems.
9.Reporting and Documentation
Prepare detailed reports for senior management on TPA performance issues and any required actions or decisions.
Ensure that all documentation related to TPA contracts performance reviews audits and other oversight activities is organized accurate and up to date.
10.Strategic Planning and Innovation
Provide strategic input into the organizations broader outsourcing strategy helping identify potential new TPAs or services to improve quality.
Stay informed about industry trends and new technologies that may improve
Co/Actions third-party administration strategy or service delivery.
**This is not a fully remote position. Applicants must sit in our Morristown NJ office on our hybrid work schedule.**
Salary range specific to for this role : 99000-$135000 discretionary incentive bonus benefits depends on various factors including without limitation individual and organizational performance. The offered rate of compensation will be based on individual education experience and addition employees are eligible for standard benefits package including paid time off medical dental and retirement.
Equal Opportunity Employer
Coaction is an Equal Employment Opportunity employer. Coactions policy is not to discriminate against any applicant or employee based on race color religion national origin gender age sexual orientation gender identity or expression marital status mental or physical disability and genetic information or any other basis protected by applicable law. Coaction also prohibits harassment of applicants or employees based on any of these protected categories.
If your application is selected you will receive an email directly from the Coaction Recruiting Team at asking you to contact a member of the Coaction Recruiting Team. Any other method of contact may be fraudulent.
Required Experience:
Manager
About Company
Coaction creates unrivaled value for customers by exceeding expectations, accomplished through a unique performance culture and desire to succeed at uncommon challenges.
