Job Details The TPL Manager is responsible for leading a highly skilled team in the identification, coordination, and recovery of medical claims expenses from third-party resources. This role ensures compliance with regulatory and contractual requirements, optimizes reimbursement opportunities, and continuously improves operational efficiency. The TPL Manager is directly accountable of staff for the intake, analysis, and reconciliation of third-p...
Job Details Working under the general supervision of the Manager of Provider Reimbursement, perform contract configuration and financial analysis for managed care contracts. In addition, generate monthly reports of revenue trends and performance statistics. The position requires sophisticated managed care analytical skills and configuration experience. The position is responsible for maintaining payment accuracy as defined by negotiated contracts...
Job Details The Director, Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and methodologies, network reimbursement / financial analyses, and related reimbursement operations. The position is responsible for oversight of all reimbursement functions for the HPP Pennsylvania provider network and future expansion markets. Job Description Responsible for establishing reimbursement methodologies, stra...
Job Details Serve as the primary point of contact and operational lead responsible for managing the procurement, administration, and ongoing performance of Pharmacy Services for members of JHP and HPP Oversee contractual, financial , operational, clinical and quality aspects related to pharmacy benefits, ensuring alignment with business objectives and regulatory compliance. Provide strategic and operational oversight to optimize pharmacy benefit ...
Job Details We are seeking a Chief Actuary to lead the actuarial strategy and execution across our government-sponsored health programs, including Medicaid, Medicare, CHIP, and ACA. This executive will serve as a key member of the leadership team, responsible for driving pricing strategy, reserving accuracy, and trend analytics that support sustainable growth and financial performance. The ideal candidate will bring deep technical expertise, a st...
