A Third Party Administrator is a company that provides operational services such as claims processing and employee benefits management. Most insurance companies and self-insured companies outsource their claims processing to third-party administrators. Common work activities relevant to the post are listed on the Third Party Administrator Resume as – performing administrative services and processing claims under a service contract, collecting charges and bills; undertaking responsibility for record-keeping of the policyholder, maintaining of customer data, and investigating records in case of any suspicious cases or false claims.
As the role is crucial, a high degree of integrity and accuracy is expected from third-party administrators. Other needed skills include the following – quality in the delivery of services, punctuality, and knowledge of using relevant software. A degree is not a mandatory requirement, though will be beneficial to undertake large projects.
Summary : Over 11 + years of IT experience in Analysis, design and development of software applications with all 11 years of experience in data warehousing with Informatica as a data integration tool Netezza, Teradata, DB2UDB, Oracle databases in a dimensional model data warehouse environment with experience in various capacities and designations from Programmer, Liaison to Project Lead/ Tech Lead.
Skills : Proficient With Microsoft Office, Typing - 80 Wpm, Transcription.
Description :
Loaded data into the Operational Data Store (ODS) and the Enterprise Dimensional Model (EDM).
Received as branded (NCAS) an unbranded (CFA) to CareFirst.
NCAS shall provided both sets of data which includes claims, enrollments, employer groups, products.
Used for corporate reporting where the build of reports will be part of a separate corporate initiative.
Led a team of three developers and a tester in Care First Corporate Initiatives.
Maintained communication within the company and with vendors and members via telephone, email and written correspondence.
Directed claims management of new/open claims of 75 plus files.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Technology
Third Party Administrator Resume
Objective : Results-Oriented Director Third Party Administrator Professional, Business Unit Management and Customer Support Services Management with 20+ years experience rolling out new business activities while maintaining and enhancing existing client base. Excel at strategic planning, project management, implementation of best practice methodologies and continuous improvement programs, as well as training and managing team members in the various disciplines. Strategically and cost effectively use technologies to improve operations and expand performance levels.
Skills : Good working knowledge of Epic System, Allscripts PM and EHR systems, Compulink, Payerpath, Emdeon, Medfusion, Demandforce, Microsoft Word/Excel/Outlook.
Description :
Directed operations for this industry-leading Third Party Administrator for life and health insurance company partners.
Promoted twice in five years, and served at the Director level, reporting directly to the Executive Vice President for fourteen years.
Directed the activities of customer service, claims processing, enrollment/application processing, certificate issuance, and individual medical underwriting and managed staff complements ranging from 12 to 21.
Focused was on ensuring best-in-class service for existing accounts, as well as timely and accurate processing of claims.
Director of Member Services Successfully implemented approximately ten new business accounts per year each year , ranging in size from 250 to 13,000 certificate holders and representing annual premiums of $30M+.
Led my team to routinely meet performance requirements for our accounts; achieve less than 2% abandoned calls; acknowledge callers within 30 seconds 80% of the time; respond to written inquiries within three business days; respond to email inquiries within one business day, usually the same day; maintain quality performance of 98% or greater.
Successfully developed and implemented enrollment via the phone for Accidental Death and Dismemberment products which resulted in sales of $5M+ in the first twelve months.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Third Party Administrator Resume
Objective : To acquire a Third Party Administrator position in which I can utilize my education and work experience to contribute to the success of your business.
Skills : MS Programs, Administrative Skills.
Description :
Self-Insured Workers Compensation.
Responsible for 50 National Self-Insured Accounts.
Maintained a caseload of 120 claims.
Demonstrated outstanding case management and dedication to clients, as evidenced by repeated promotions throughout tenure.
Developed and managed claims through well-developed action plans to bring claims to an appropriate and timely resolution.
Responsible for composing all correspondence related to claims management.
Responsible for maintaining medical documentation and updating the clam system with ongoing chart notes.
Experience
2-5 Years
Level
Junior
Education
Diploma In General Studies
Third Party Administrator Resume
Headline : Looking for an opportunity in Managing in the Mail Industry. I know mail inside and out. Running and training staff on equipment. Knowing all the industry standards. Imaging and scanning. Providing daily schedules. Spreadsheets, reports, and goals. Along with basic office skills.
Managed benefit office including eligibility, accounting, claims, pension processors, and clerical staff.
Included acting as primary contact for 12 small-to-mid-sized accounts.
Coached teams to ensure goals were achieved, handled escalated issues, evaluated performances, and set individual goals.
Successfully produced a profit for the company in each year.
Achieved a very high ratio of retained clients.
Developed and maintained excellent relationships with all vendors and other providers of services.
Reported directly to the VP of Sales.
Experience
5-7 Years
Level
Executive
Education
GED
Third Party Administrator Resume
Headline : A seasoned underwriter with 7 years of Personal Lines Homeowners Insurance and 22 years in all lines of Commercial Insurance including Workers' Compensation. I am well qualified, versatile, and adaptable in an ever-changing work environment. Core Qualifications Proficiency in Underwriting Strong attention to detail Client-focused Strong analytical skills Results-oriented Team Player.
Skills : MS Office, Implementational Skills.
Description :
Reviewed, maintained, and implemented underwriting philosophy, strategy and guidelines for personal lines homeowners' insurance coverage for assigned states and agents.
Made informed and appropriate underwriting decisions based on information provided by clients, agents and other sources.
Handled underwriting referrals or other assigned risk reviews, including making and implementing underwriting decisions on new business, renewals and endorsements.
Effectively interacted with all levels of internal and external business partners by communication with agents and other company personnel with regards to insureds, policies, coverages and risk eligibility either by phone an/or email correspondence.
Implemented technical expertise and product/coverage specific knowledge when handling homeowners' coverage for assigned states.
Collaborated with other underwriters, operations, claims, marketing and customer service reps within a team environment.
Reviewed external home inspections performed by the National Risk Insurance Services & and take action as needed for any underwriting issues and/or hazards found.
Experience
5-7 Years
Level
Junior
Education
Diploma In Education
Third Party Administrator Resume
Summary : Achievement-oriented Third Party Administrator professional with 20+ years' diversified experience in accounting, fund/cash flow management, business support, performance reporting, and financial analysis, business strategies. Strong PC/spreadsheet skills, slide presentations, excellent multi-tasking and organizational aptitudes, and proven ability to influence business partners.
Skills : Administration, Office, Insurance.
Description :
Extended service warranties on home appliances, auto and telephone systems.
Managed fixed assets.
Analyzed general ledger and prepared pre-audit working papers.
Analyzed potential acquisitions and made recommendations on their viability and suitability for acquisition.
Analyzed and reconciled inter-company accounts.
Supervised staff of two accounting clerks.
Built and managed company's fixed asset system on excel.
Experience
10+ Years
Level
Senior
Education
MBA In Accounting
Third Party Administrator Resume
Objective : Third Party Administrator experienced at registering patients, scheduling appointments and recording and filing patient medical records. Enters orders and information quickly and accurately. CORE Maintaining strict confidentiality ICD-9 coding Knowledge of HMOs, Medicare and Medi- CPT and HCPCS coding Cal HIPAA compliance Strong work ethic Medical billing software Strong planning skills.
Skills : Call Cneter, Call Center, Customer Service.
Description :
Strictly followed all federal and state guidelines for release of information.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Monitored shared email in-boxes and ensured inquiries were addressed.
Accurately entered procedure codes, diagnosis codes and patient information into billing software.
Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
Consistently ensured proper coding, sequencing of diagnoses and procedures.
Quickly responded to staff and client inquiries regarding CPT codes.
Experience
2-5 Years
Level
Executive
Education
Associate Of Science
Third Party Administrator Resume
Objective : Experienced analyst seeking a new opportunity. Seeking a role within a firm that would allow me to both further utilize my skills and grow professionally, all while driving the growth of my employer.
Skills : Microsoft Office, Social Medical, Accounting, Customer Service.
Description :
Submitted payroll weekly, semi-monthly, monthly and quarterly.
Processed funds to investment companies.
Mailed quarterly statements to participants.
Inter-acted with over 120 companies.
Assist with sending distribution paperwork to terminated participants, process distribution paperwork, and liaison between financial institutions and investment companies.
Provided information for new enrollments to company liaison.
Supported Trustees with hardship and loan distributions.
Experience
2-5 Years
Level
Executive
Education
MS
Third Party Administrator Resume
Summary : A highly motivated, self-starter with diversified experience and a successful track record. Proven in claims handling, customer service, and risk assessment. Possesses strong organizational, communication, and presentation skills.
Skills : Customer Service, Banking, Insurance, Data Entry, Accounts Payable.
Description :
Presented Gallagher Bassett Services is a wholly-owned subsidiary of Arthur J. Gallagher & Co. that is a Third Party Administrator providing claim services to accounts.
Managed General liability, Auto Liability for both property damage and personal injury claims, also manages First Party Property Contents and Business Income claims.
Prepared client and excess carrier reports.
Prepared and presented files for claim reviews and settlement authority.
Evaluated files to determine if any subrogation potential.
Evaluated files and investigates for contribution of any other tortfessors for referral of the claim to be resolved.
Reconciled with investment companies to make sure each individual has received their contributions quarterly.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Arts In Political Science
Third Party Administrator Resume
Objective : Third-Party Administrator who undertakes complex assignments, meets tight deadlines and delivers superior performance. Possesses practical knowledge in corporate Vendor and Project Management. Applies strong business development and compliance skills to inform senior management of key trends to reduce company expenditures.
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