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In the United States, a third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. [1] It is also a term used to define organizations within the insurance industry which administer other services such as underwriting and customer service.
The collapse of claims management company the Accident Group in 2003 increased disquiet with the system. Such companies used aggressive sales techniques and exaggerated claims, profiting from exorbitant commissions on after the event insurance policies. It was estimated that there were about 1,000 such companies in the UK in 2003. [2]
Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
A job description or JD is a written narrative that describes the general tasks, or other related duties, and responsibilities of a position. It may specify the functionary to whom the position reports, specifications such as the qualifications or skills needed by the person in the job, information about the equipment, tools and work aids used, working conditions, physical demands, and a ...
Among other initiatives, by 2011 the Branch plans to implement a Disability Insurance Automation project for more efficient and effective electronic communications and information processing. [ 9 ] [ 10 ] The state's legal and regulatory requirements for the Branch's programs are found in the California Unemployment Insurance Code, the ...
Human resources (HR) is the set of people who make up the workforce of an organization, business sector, industry, or economy. [1] [2] A narrower concept is human capital, the knowledge and skills which the individuals command. [3]