Operations and Service Coordinator

As a member of the TPA Compliance Team, this role is responsible for operational compliance and process coordination including the oversight of client enrollment into our enhanced services, Medicare and Section 111 Compliance, jurisdictional and organizational compliance initiatives, strategic vendor management coordination, and optimizing operational efficiency and effectiveness.

Responsibilities

• Participate in strategic internal and client discussions to coordinate a seamless enrollment in enhanced services in accordance with the agreed upon timeframes, maintaining consistent records and tracking mechanisms throughout enrollment process from receipt of notification through completion of setup
• Evaluate client contracts and internal implementation notifications to determine account specific guidelines or other potential factors that may impact enrollment
• Maintain list of prospective and active client lists for enhanced services customer enrollments
• Prepare and distribute organizational charts for the TPA
• Monitor regulatory and jurisdictional compliance updates, create and maintain repository of information, and distribute notification to all relevant stakeholders
• Develop and implement comprehensive non-billing audits and monitoring tools and reporting templates to provide vendor oversight for all TPA functions
• Work in close partnership with claims and client-facing resources to support the TPA business objectives and growth goals
• Provide high-level system support to the client facing resources and claim teams, focused on proactive claim approaches to ensure compliance in accordance with associated jurisdictional, system, and organizational requirements.
• Serve as primary liaison and point of contact for all Medicare and Section 111 Compliance related matters including registrations, issue resolution, and error resolutions
• Monitor and evaluate the Mandatory Insurer Reporting process to ensure transmission accuracy and coordinate with internal partners for areas of opportunity to improve the error ratio (i.e. system augmentation, staff training, etc.)
• Oversee monthly leakage reporting and trending analysis to ensure utilization of preferred strategic vendor partnerships
• Participate in project management pursuant to changing governing rules and regulations
• Provide recommendations for ongoing process improvement
• Complete additional special projects, compliance initiatives and job duties as assigned.
• Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
  
  

Requirements

• Bachelor's degree or equivalent work experience preferred.
• 1-3 years of commercial lines claims experience preferred.
• Advanced skills in applying sound judgement to data analysis; ability to problem solve, establish goals, and implement action plans.
• Excellent interpersonal skills and ability to effectively communicate to all levels within the company.
• Demonstrated ability to effectively and professionally coordinate and complete multiple tasks and projects of differing types and complexity and due dates.
• Demonstrated organizational skills with strong attention to detail, the ability to manage multiple tasks simultaneously and maintain a high level of accuracy.
• Strong computer software skills, proficient in Microsoft Office applications, SharePoint experience a plus.