What are the responsibilities and job description for the TPA Manager position at RYZE Claim Solutions?
Overview: The TPA Manager is responsible for the day-to-day account management, supporting, and providing leadership to the staff of internal claims professionals.
Essential Functions:
• Responsible for the allocation of work throughout the team. • Provide guidance and support to employees, enabling them to maximize their potential in meeting a variety of demands. • Identify and proactively address employee issues, such as performance and day-to-day needs to ensure highest levels of service, resulting in excellent customer satisfaction. • Resolve issues and/or complaints. • Perform regular monthly, quarterly and annual audits for quality assurance. • Ensure that claims are being processed as expeditiously as possible, and that all inventories are regularly reviewed and all possible actions are taken to move the claims to closure. This involves daily review of aging, inventory, productivity, and other reports to identify problems and take corrective actions. • Work with Leadership team to constantly improve claim handling processes, systems, communication and overall team effectiveness. • Respond to correspondence for assigned TPA carriers as determined for each carrier – e.g. POL/responses to denials/complaints. • Provide guidance on handling of complex claims to staff when requested. • Communicate directly with client to identify any issues or concerns as necessary. • In event of a catastrophe that requires a ramp-up and response, support efforts to prepare the staff. • Other duties as assigned.
Requirements:
- Bachelor’s degree (B.S. or B.A.), or equivalent from a four-year college, in the area of specialty; and at least 5 years of related experience in field; or the equivalent combination of education and experience.
- 3 years of management experience.
- Previous TPA experience strongly preferred.
- Excellent oral & written communication
- Proficient computer & typing skills - working knowledge of MS Office: Word, Excel, and Outlook.
- Proficient with Xactimate estimating software.
- Strong investigative, analytical, and problem-solving skills
- Familiar with a variety of the field’s concepts, practices, and procedures.
- Ability to speak Spanish a plus.
