TPA Insurance Operations Coordinator

Minneapolis · Full-time, Temporary

About The Position

Gravie Administrative Services LLC is a licensed third-party administrator that administers self-funded medical and HRA plans for employers. The TPA Insurance Operations Coordinator is responsible for resolving problematic situations efficiently and will have excellent communication and organizational skills. Role works to ensure the smooth daily operations of the business.

Gravie is looking for a local Minneapolis/St Paul TPA Insurance Operations Coordinator for an immediate full time, temporary assignment through 2020. Work from home capabilities also needed.

YOU WILL:

●     Ensure member eligibility requirements are met, and work to resolve any questions or discrepancies that are raised

●     Triage complex questions to the appropriate teams/resources within the TPA team to resolve issues and respond accordingly, and coordinate with various departments to resolve issues when needed

●     Accurately and efficiently collect and input pertinent information obtained into the appropriate company systems

●     Review and process HRA claims accurately and effectively

●     Determine and ensure payment is correct, by verifying proper authorizations and payment procedures are being followed

●     Establish proof of loss by studying medical documentation, assembling additional information as required from outside sources including claimant, physician, employer, hospital, and other insurance companies

●     Document medical claims actions. Includes documenting approvals and denials by calculating benefits due, initiating payment or composing denial letters

●     Review auto adjudication of claims

●     Work closely with any associated vendors to answer questions, research issues and provide great customer service

●     Prepare reports by collecting, analyzing, and summarizing information

●     Collaborate in projects to support other functions of the TPA including enrollment, eligibility and customer service

●     Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations. Maintain all necessary levels of member/patient privacy in accordance with HIPAA standards

●     Maintain the highest level of customer service by following best practices and responding to all customer and departmental inquiries in a timely and high-quality fashion

●     Assist with various administrative functions, including processing and sorting incoming mail, stuffing envelopes and mailing new/replacement member ID cards for the TPA team

●     Assist with member advisor phone calls based on business needs (triaging as appropriate)

●     Demonstrate Gravie’s core competencies of authenticity, curiosity, creativity and an outcome orientation

●     Other duties as assigned

YOU BRING:

●     1 year of outstanding customer service experience

●     Strong analytical and problem-solving skills, ability to think outside the box

●     Strong workload prioritization skills to meet expected deadlines

●     Ability to navigate through multiple systems to complete the task at hand

●     Flexibility to fluctuating work schedules, along with support of the team, including work from home and training

●     Ability to collaborate and work well within a small team setting

  • Work effectively with all teams across the organization, to further the goals of the business

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