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TPA Auditor

Expired Job

The IHC Group Phoenix , AZ 85002

Posted 4 months ago

SUMMARY

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.

ESSENTIAL DUTIES ANDRESPONSIBILITIES

  • 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

REQUIREMENTS

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.

SUPERVISORYRESPONSIBILITIES

  • None

CERTIFICATES,LICENSES, REGISTRATION

  • None

PHYSICALDEMANDS

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.

WORKENVIRONMENT

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.


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TPA Auditor

Expired Job

The IHC Group