Top 42 Third party administration tpa benefit Jobs in Remote

Utilization Review Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
12d
Payroll Specialist (Contractor)
Harbor Compliance —Remote
- Contract
- Remote
- Mid-level
- 2 years
- 401(k)
- Parental leave
Quick Apply
14d
Operations Analyst
Maxor National Pharmacy Services, LLC —Remote
- Full-time
- Microsoft Access
- Microsoft Outlook
- Research
- AD&D insurance
- Disability insurance
Quick Apply
Retirement Plan Services Onboarding Specialist
EARNED —Remote
- $90,000 - $100,000 a year
- Full-time
- 5 years
- Mid-level
- Finance
- Health insurance
- Dental insurance
Remote Retirement Plan Compliance Analyst
Ascensus —Philadelphia, PA
- $65,000 - $95,000 a year
- Online Application
- Remote
- Microsoft Outlook
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Account Manager- Health Benefits TPA
ASR CORPORATION —Grand Rapids, MI
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health insurance
- Dental insurance
Specific Claims Auditor
Tokio Marine HCC —Remote
- $40,300 - $88,800 a year
- Overtime
- Background check
- Microsoft Excel
- Computer literacy
- Wellness program
- Paid parental leave
Account Executive- Health Benefits TPA
ASR CORPORATION —Grand Rapids, MI
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health insurance
- Dental insurance
13d
Claims Adjuster/Examiner
Jones Jones LLC —New York, NY
- $50,000 - $85,000 a year
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
Quick Apply
Retirement Plan Onboarding Administrator, (HSR)
Strongpoint Partners —Chicago, IL
- $75,000 - $90,000 a year
- Remote
- Microsoft Outlook
- Mid-level
- Finance
- Disability insurance
- Health insurance
Quick Apply
Retirement Plan Services Onboarding Lead
EARNED —Remote
- $140,000 - $150,000 a year
- Full-time
- 7 years
- Mid-level
- Finance
- Health insurance
- Dental insurance
Sr. Operations Analyst
Maxor National Pharmacy Services, LLC —Remote
- Full-time
- Microsoft Access
- Microsoft Outlook
- 5 years
- AD&D insurance
- Disability insurance
Quick Apply
Senior Data Engineer – Insurance Data Platform
CCMSI —Danville, IL
- $100,000 - $150,000 a year
- Monday to Friday
- Remote
- System design
- HIPAA
- 8 years
- Paid holidays
- Disability insurance
14d
Retirement Plan Administrator, (RPA)
Strongpoint Partners —Falls Church, VA
- $80,000 - $90,000 a year
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Senior Security Analyst - REMOTE
S&S Healthcare —Cincinnati, OH
- $120,000 - $140,000 a year
- Remote
- Pass drug screening
- HIPAA
- Analysis skills
Quick Apply
AVP Claims, Workers Compensation (Fully Remote)
NIP Group, Inc. —Woodbridge, NJ
- $140,000 - $170,000 a year
- Remote
- 7 years
- Microsoft Excel
- Management
- Health insurance
- Dental insurance
Provider Relations Representative
Key Family of Companies —Austin, TX
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Retirement Plan Manager; 3(16) Services
Strongpoint Partners —Chicago, IL
- $45,000 - $55,000 a year
- Full-time
- Remote
- 5 years
- Mid-level
- Finance
- Disability insurance
- Health insurance
Quick Apply
14h
Claims Program Manager, MBU- Eatontown, NJ or Remote
Crum & Forster —Eatontown, NJ
- $58,700 - $110,200 a year
- Remote
- Microsoft Excel
- 6 years
- Microsoft Outlook
- Employee stock purchase plan
- Health insurance
Regional Sales Director, TPA Solutions
Crumdale Specialty —Paoli, PA
- Full-time
- Remote
- 5 years
- Data analysis skills
- Travel
- AD&D insurance
- Health insurance
Quick Apply

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third party administration tpa benefit jobs near remote

Utilization Review Nurse

Cobalt Benefits Group LLC -
Dallas, TX

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Job Details

Full-time
$90,000 - $98,000 a year
12 days ago

Benefits

Health savings account
AD&D insurance
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Vision insurance

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
RN License
Patient care
Desktop applications
Resource utilization in healthcare

Full Job Description

Description:

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.

The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and levels of care in accordance with established criteria, payer guidelines, and organizational policies. This role involves evaluating healthcare services and facilities under the provisions of applicable health benefit plans to ensure quality and cost-effective patient care.

The UR Nurse collaborates closely with intake staff, physicians, specialists, case managers, and other members of the care team to facilitate timely and effective care authorizations, transitions, and utilization determinations. Strong communication, clinical judgment, and attention to detail are essential to ensure services meet both clinical standards and benefit requirements.

Responsibilities

Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria.
Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria.
Request and evaluate clinical information needed to review requested services.
Discuss cases and determinations with healthcare professionals and physician reviewers.
Identify cases requiring intervention and collaborate with Case Managers as needed.
Maintain appropriate and accurate documentation, ensuring compliance with audit standards.
Participate in team meetings, educational sessions, and related activities.
Review medical claims and pre-determinations for medical necessity and appropriateness.
Identify opportunities for process improvement and enhance communication among departments.
Consult with Physician Reviewers for complex or challenging cases.

Requirements:

Current, unrestricted RN license (State license required).
Minimum 3 years of clinical nursing experience.
Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Strong analytical, critical thinking, and problem-solving skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with utilization management systems.
Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
Strong organizational and time management skills, with the ability to handle multiple priorities independently.

Preferred Qualifications

Experience with Milliman or Aetna criteria.
Background in healthcare administration, medical necessity determination, or benefits management.
Experience in data interpretation and medical trend analysis.

Work Environment & Physical Demands

Prolonged periods of sitting may be required.
Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
Employees should ensure an ergonomically appropriate desk and chair setup.
Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)

Benefits:

After successfully completing a waiting period, eligible full-time employees have access to our comprehensive benefits package, including:

Fantastic medical, dental, and vision insurance*
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company-provided Basic Life and AD&D
Company-paid Short-Term and Long-Term Disability**
Flexible Spending Accounts*
401(k) Retirement Plan with up to a 6% employer match** (100% fully vested after 3 years)
10+ paid holidays
Half-day Summer Fridays
Generous paid vacation and sick time
Annual paid Volunteer Day
Annual Tuition reimbursement
Annual Health and Wellness reimbursement
Lots of fun company events

Benefit Waiting Period Notes: *60-day waiting period, **90-day waiting period

Who We Are

As a trusted Third-Party Administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four companies: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue, and Great Bay Administrators. With over 30 years of experience and a dedicated team of nearly 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Cobalt Benefits Group is one of the fastest growing TPA's in the country and the fastest growing in New England. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit www.cobaltbenefitsgroup.com/careers.

Quick Apply

Refine Your Search

third party administration tpa benefit jobs in remote

Utilization Review Nurse

Payroll Specialist (Contractor)

Operations Analyst

Retirement Plan Services Onboarding Specialist

Remote Retirement Plan Compliance Analyst

Account Manager- Health Benefits TPA

Specific Claims Auditor

Account Executive- Health Benefits TPA

Claims Adjuster/Examiner

Retirement Plan Onboarding Administrator, (HSR)

Retirement Plan Services Onboarding Lead

Sr. Operations Analyst

Senior Data Engineer – Insurance Data Platform

Retirement Plan Administrator, (RPA)

Senior Security Analyst - REMOTE

AVP Claims, Workers Compensation (Fully Remote)

Provider Relations Representative

Retirement Plan Manager; 3(16) Services

Claims Program Manager, MBU- Eatontown, NJ or Remote

Regional Sales Director, TPA Solutions

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