Tpa Jobs (NOW HIRING)

At Coaction, we're 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 TPA's. 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:

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• Provide strategic input into the organization's 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/Action's 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 : 99,000-$135,000 + 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 qualifications. In 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. Coaction's 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 coaction@myworkday.com asking you to contact a member of the Coaction Recruiting Team. Any other method of contact may be fraudulent.