WebTPA

The Claims Examiner is responsible for processing and adjudicating healthcare claims across medical, dental, vision, and mental health accounts. This includes conducting claims research, managing overpayment recovery, and resolving claims appeals while meeting production standards.

Provide comprehensive legal counsel on healthcare regulatory matters and serve as a primary advisor to business units on federal and state requirements. Monitor regulatory trends, conduct risk assessments, and develop compliance policies to mitigate organizational risk.

The RN Case Manager creates and monitors treatment plans to help members meet healthcare goals while ensuring cost-effectiveness. Responsibilities include assessing health status, coordinating with providers, and reviewing medical records for necessity.

The Senior Systems Auditor will assist management in conducting IT risk audits, focusing on application, OS, and database security, internal security architecture, and data privacy processes. Responsibilities include executing key control testing across various technical environments and tracking the remediation of identified risks.