Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

TPA Auditor

Expired Job

The IHC Group Phoenix , AZ 85002

Posted 4 months ago


In this role, you will utilize detail drivenand customer service focused skills by conducting audits to ensure the ThirdParty Administrators (TPAs) and other external entities are maintaining andimplementing our products and policies in a manner consistent with our companygoals. In this position, you willcollaborate with other departments including compliance, internal audit,product development, actuarial and sales. You will play an integral part in identifying opportunitiesfor improvement with our TPA partners. In addition, you may be involved inassisting with the implementation of new TPAs and maintaining ongoingrelationships with TPAs.


  • PerformingTPA and other external entity audits. This will entail a variety of responsibilities that may includereviewing calls from agency call centers to ensure our customers are providedquality service, locating and reviewing external entity websites to ensurecompliance with company policies, determining new opportunities to review basedon your experiences with the TPAs, and other audit functions as assigned

  • Providingreports on audit results and identifying opportunities for improvement with TPAadministration and other external entities

  • Assistingwith TPA implementations by helping to coordinate tasks and gather informationand documents that may be needed

  • Developingand maintaining relationships with TPA partners, as assigned

  • Representingthe TPA Administration department in various meetings

  • Workingclosely with other departments to accomplish TPA department goals

  • Otherduties as assigned


To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essentialfunctions.

  • Previous experience with ancillary health benefit plans (STM, LMB, HIP, etc)

  • Preferred previous auditing experience within a health insurance environment

  • Accuracy in daily and project work.

  • Ability to meet schedules and deadlines.

  • Ability to use experience and judgment to plan and accomplish goals

  • Excellent written and verbal communications skills; ability to manage multiple details

  • Ability to create innovative solutions to problems and business opportunities

  • Demonstrated ability to interact with all levels of an organization

  • Strong ability to develop effective relationships with co-workers and customers

  • Ability to operate in a fast-paced environment.

  • Professional verbal and written communication skills and the ability to communicate with discretion and understanding when confidentiality is needed.

  • Proficient in Microsoft Office suite.


  • None


  • None


The physical demands described here arerepresentative of those that must be met by an employee to successfully performthe essential functions of this job. Reasonable accommodations may be made toenable individuals with disabilities to perform the essential functions.

Small Motor skills: Picking, pinching, typing or otherwise working primarily with fingersrather than with whole hand or arm, as in handling.

Speaking: Expressing or exchanging ideas by means of spoken word. Those activities in which requires detailedor important spoken instructions must be conveyed to other workers accuratelyand quickly.

Hearing: Ability to receive detailed information through oral communication withor without correction.

Repetitive motion: Substantial movement (motions) ofthe wrist, hand and fingers.


Thework environment characteristics described here are representative of those anemployee encounters while performing the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.

Normaloffice environment with controlled temperature.

upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
TPA Account Manager

Aetna Inc.

Posted 6 days ago

VIEW JOBS 1/11/2019 12:00:00 AM 2019-04-11T00:00 Job Description POSITION SUMMARY The TPA Account Manager is responsible to work in conjunction with our brokers, clients and partners to achieve customer satisfaction. The primary role of the Account Manager is to execute on strategies, ensure client renewal and achieve growth objectives year over year. Fundamental Components: Executes tactical components on behalf of each client * Understand competitive environment and market opportunities Establish and maintain relationships with appropriate internal partners (underwriting, sales, operations, business analytics, etc) Work collaboratively across business functions to ensure customer needs are met Follows through on outstanding items to point of resolution Monitors on an ongoing basis internal performance to ensure clients needs are being met Maintain accurate client records Participate and/or host client meetings as appropriate Organize and execute open enrollment strategy, health fairs, employee education meetings as required * Manage renewal negotiations to completion BACKGROUND/EXPERIENCE desired: 3-5 Years of industry experience Strong understanding of health plan market Licensure as required by State College degree or equivalent work experience EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. LICENSES AND CERTIFICATIONS Insurance/Licensed Life and Health Producer is desired FUNCTIONAL EXPERIENCES Functional - Sales & Service/Account Management/4-6 Years Functional - Sales & Service/Self insured/stop loss products/4-6 Years Functional - Medical Management/Medical Management - Administration/Management/4-6 Years TECHNOLOGY EXPERIENCES Technical - Desktop Tools/Microsoft Outlook/4-6 Years/Administrator Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User Technical - Remote Access/Citrix/1-3 Years/End User Telework Specifications: Locations: Amherst, New York: Minneapolis,Minnesota; Tampa, Florida, Omaha, Nebraska ADDITIONAL JOB INFORMATION Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately. Aetna Inc. Phoenix AZ

TPA Auditor

Expired Job

The IHC Group