TPA Executive

Claims Administration

1. Process and settle insurance claims on behalf of the insurer or self-funded plan.

2. Review and verify claim documentation.

3. Determine claim eligibility and coverage.

Benefits Administration

1. Manage employee benefits, including health, dental, and vision plans.

2. Handle enrollment and eligibility issues.

3. Provide benefits information to employees.

Customer Service

1. Respond to customer inquiries and concerns.

2. Provide claims status updates.

3. Resolve issues and complaints.

Reporting and Compliance

1. Generate reports on claims activity and benefits administration.

2. Ensure compliance with regulatory requirements.

3. Maintain accurate records.

Network Management

1. Manage relationships with healthcare providers.

2. Negotiate contracts with providers.

3. Ensure network adequacy.

Other Duties

1. Conduct audits to ensure accuracy and compliance.

2. Implement and manage benefits programs.

3. Provide data analytics and insights.