At least 3-5 years of Quality Analyst in healthcare,TPA, or health plan settings/ healthcare claims ... Familiarity with Medi-Cal and Commercial insurance claim * Strong analytical and problem-solving ...
At least 3-5 years of Quality Analyst in healthcare,TPA, or health plan settings/ healthcare claims ... Familiarity with Medi-Cal and Commercial insurance claim * Strong analytical and problem-solving ...
Foreclosure - Specialist [TPA]
Tampa, FL · On-site +1
... Insurance, and Employee Assistance Program 401k (with company match) Extensive Training and Development Opportunities Flexible work schedules including in-office, hybrid, and remote working ...
Foreclosure - Specialist [TPA]
Tampa, FL · On-site +1
... Insurance, and Employee Assistance Program 401k (with company match) Extensive Training and Development Opportunities Flexible work schedules including in-office, hybrid, and remote working ...
Director Business Development - Florida
Sunrise, FL · On-site +1
Previous experience with Risk Management TPA and insurance sales and services as well as managing ... EM3 #LI-REMOTE * Develops strategic sales plans and procedures for designated territory.
Director Business Development - Florida
Sunrise, FL · On-site +1
Previous experience with Risk Management TPA and insurance sales and services as well as managing ... EM3 #LI-REMOTE * Develops strategic sales plans and procedures for designated territory.
Associate Director, Provider Marketing
Tampa, FL · Remote
$38K - $52K/yr
We are seeking a full-time, remote Associate Director of Provider Marketing. The Associate Director ... Understand all external influencers such as TPA, reinsurers, and employees. * Maintain a good ...
Associate Director, Provider Marketing
Tampa, FL · Remote
$38K - $52K/yr
We are seeking a full-time, remote Associate Director of Provider Marketing. The Associate Director ... Understand all external influencers such as TPA, reinsurers, and employees. * Maintain a good ...
Multi-Line Claim Adjuster
Maitland, FL · On-site +1
$85K - $90K/yr
Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim ...
Multi-Line Claim Adjuster
Maitland, FL · On-site +1
$85K - $90K/yr
Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim ...
Multi-Line Claim Consultant
Maitland, FL · On-site +1
$85K - $90K/yr
Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim ...
New
Multi-Line Claim Consultant
Maitland, FL · On-site +1
$85K - $90K/yr
Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim ...
New
Associate Director, Provider Marketing
Tampa, FL · Remote
$38K - $52K/yr
We are seeking a full-time, remote Associate Director of Provider Marketing. The Associate Director ... Understand all external influencers such as TPA, reinsurers, and employees. * Maintain a good ...
Associate Director, Provider Marketing
Tampa, FL · Remote
$38K - $52K/yr
We are seeking a full-time, remote Associate Director of Provider Marketing. The Associate Director ... Understand all external influencers such as TPA, reinsurers, and employees. * Maintain a good ...
Remote Tpa Insurance information
What are the main challenges faced by professionals working remotely in TPA insurance roles, and how can they be addressed?
Professionals in remote TPA (Third Party Administrator) insurance roles often face challenges such as maintaining clear communication with clients, managing sensitive data securely, and staying updated on regulatory changes. To address these, it’s important to utilize secure collaboration tools, establish regular virtual meetings, and participate in ongoing training. Building strong digital workflows and maintaining responsiveness help ensure high service quality and effective teamwork, even when working from different locations.
What is the difference between Remote Tpa Insurance vs Remote Claims Adjuster?
| Aspect | Remote Tpa Insurance | Remote Claims Adjuster |
|---|---|---|
| Credentials | Insurance licenses, TPA certifications | Adjuster licenses, insurance knowledge |
| Work Environment | Home-based, insurance company or TPA firm | Home-based, insurance carriers or third-party administrators |
| Industry Usage | Used by TPAs managing claims for insurers | Handles claims processing and settlement |
| Job Focus | Managing claims processes, compliance, client communication | Evaluating damages, settling claims, investigations |
Remote Tpa Insurance and Remote Claims Adjuster roles both involve claims management but differ in focus. TPA professionals oversee claims processes for insurers, often working within third-party administration firms, while claims adjusters evaluate damages and settle claims directly. Both roles require insurance knowledge and licenses, but their daily tasks and employer types vary.
What is a Remote TPA Insurance job?
A Remote TPA (Third Party Administrator) Insurance job involves managing insurance claims, policies, and administrative tasks for insurance companies from a remote location. TPAs act as intermediaries between insurance companies and policyholders, handling claims processing, customer service, and compliance tasks. Working remotely means these professionals use digital tools and communication platforms to perform their duties outside of a traditional office setting. Remote TPA Insurance jobs require strong organizational, communication, and technical skills, as well as a good understanding of insurance processes and regulations.
What are the key skills and qualifications needed to thrive as a Remote TPA Insurance professional, and why are they important?
To thrive as a Remote TPA (Third Party Administrator) Insurance professional, you need strong knowledge of insurance policies, claims processing, and regulatory compliance, typically supported by a relevant degree or insurance certifications. Familiarity with claims management systems, insurance software like Guidewire, and secure communication platforms is essential. Excellent attention to detail, organizational skills, and clear communication set top performers apart, especially in a remote environment. These skills ensure accurate claims handling, regulatory adherence, and efficient client service, which are crucial for client satisfaction and organizational success.
What are popular job titles related to Remote Tpa Insurance jobs in Florida? For Remote Tpa Insurance jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Remote Tpa Insurance jobs in Florida look for? The top searched job categories for Remote Tpa Insurance jobs in Florida are:
What cities in Florida are hiring for Remote Tpa Insurance jobs? Cities in Florida with the most Remote Tpa Insurance job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 19 days ago
Job description
Claims Quality Auditor| Remote
Job Type: Full time
Work Setup: Remote
Reports to: Claims Supervisor
Position Summary:
TheClaims Quality Auditor plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute resolution. The ideal candidatehas hands on experience withEZCap,auditing claims, analyzing dispute claims and evaluating internal policies and regulatory requirements, with a particular focus on Medi-Cal and commercial health plans.This role is responsible to partners closely with cross-functional teams to drive continuous improvement and operational excellence.
Key Duties:
- Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
- Analyze provider disputes for patterns or recurring issues.
- Identify root causes and work with relevant teams to implement corrective actions and process improvements.
- Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
- Conduct thorough root cause analyses on high-impact errors or escalations.
- Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results.
- Ensure all reviewed processes align with applicable regulatory requirements. Participate in internal and external audits as needed.
Qualifications:
- High school diploma or equivalent
- At least 3-5 years of Quality Analyst in healthcare,TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
- Hands-on experience with EZCap (strongly preferred)
- Familiarity with Medi-Cal and Commercial insurance claim
- Strong analytical and problem-solving skills
- Excellent verbal and written communication
- Attention to detail in documentation and compliance
- Ability to manage multiple tasks and meet deadlines
- Experience with other claim adjudication platforms and provider systems.
- Familiarity with DHCS, DMHC, CMS dispute handling regulations.
What We Offer
- Remote work offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
COMPANY OVERVIEW:
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.