Point C

Project Manager

• Lead and manage multiple strategic projects from initiation through completion, ensuring all objectives are met within scope, time, and budget constraints.
• Collaborate with cross-functional teams to define project goals, deliverables, and key performance indicators (KPIs).
• Develop comprehensive project plans, including timelines, resource allocation, and risk management strategies.
• Monitor project progress, identify potential risks and issues, and implement corrective actions as necessary.
• Facilitate regular project meetings, providing clear and concise updates to stakeholders and senior management.
• Ensure all project documentation is accurate, up-to-date, and accessible to relevant parties.
• Utilize project management tools and methodologies to streamline processes and enhance project outcomes.
• Foster a collaborative and inclusive project team environment, encouraging open communication and active participation.
• Conduct post-project evaluations to identify lessons learned and areas for improvement.
• Stay informed of industry trends, best practices, and regulatory changes relevant to healthcare and TPA operations.

Operations Project Manager

Auditor

• Review and audit medical claims for accuracy and compliance with company policies and benefit plan parameters.
• Listen to customer service phone calls for accuracy and professionalism.
• Provide feedback, coaching, and mentoring to claims and customer service staff members on results, best practices and compliance issues.
• Assist in training efforts as needed.
• Prepare summary and detailed reports on audit findings, trends, and recommendations for process enhancements.
• Stay updated on industry changes in medical coding, billing regulations, and insurance policies.
• Assist in developing and implementing audit policies and procedures.
• Measure and report on performance guarantee results.

Medical Claims Auditor

Risk

• Lead IT governance, including policy development, lifecycle management, and governance committee oversight
• Maintain an auditable policy library with structured review and approval processes
• Align security policies with HIPAA, HITRUST, SOC 2, and other regulatory frameworks
• Translate audit findings into actionable controls and remediation plans
• Own the IT security awareness and training program, including role-based training and phishing simulations
• Oversee vendor and third-party risk management, including due diligence, risk assessments, and ongoing monitoring
• Manage the IT risk register and drive risk mitigation strategies with executive reporting
• Support audit readiness through control testing, reporting, and coordination of internal/external audits
• Promote adoption of enterprise security standards across identity, access, and data protection

Director, Information Technology Governance

Pricing Analyst

• Review and reprice medical claims using contracted provider network rates
• Apply appropriate discounts based on PPO, rental networks, and client agreements
• Validate billed charges against fee schedules and contract terms
• Identify pricing discrepancies and escalate issues when necessary
• Communicate with internal teams regarding claim status and pricing questions
• Maintain accurate documentation and notes within claims systems
• Meet productivity and accuracy standards
• Follow HIPAA and data privacy guidelines at all times

Claims Repricing Coordinator

Administration

• Manage contracts from intake through drafting, review, negotiation support, execution, and post-execution tracking.
• Draft and revise agreements using approved templates and evaluate proposed deviations from standard language.
• Review and support negotiation of contractual terms, including indemnification, limitation of liability, termination provisions, amendments, and HIPAA privacy and security requirements.
• Ensure alignment between executed agreements, proposals, RFP responses, pricing structures, and operational capabilities.
• Manage renewals, amendments, and regulatory-driven updates.
• Identify non-standard or high-risk provisions and escalate material risks as appropriate.
• Maintain accurate contract documentation and version control.
• Collaborate cross-functionally to support compliant and efficient contract execution.
• Assist with audits, regulatory inquiries, and contract-related reporting.
• Support ongoing improvements to templates, workflows, and contract tracking processes.

Contract Administrator

Customer Support

• Collaborate closely with the sales team to support and execute stop loss marketing strategies.
• Analyze and scrub client data to prepare comprehensive and accurate marketing requests.
• Act as a liaison between stop loss carriers and the sales team, ensuring smooth communication and efficient exchange of information.
• Submit and track network reporting requests with accuracy and timeliness.
• Manage workflows and deadlines across multiple concurrent projects—organization and attention to detail are essential.
• Foster teamwork and collaboration by being a reliable, communicative, and solutions-oriented partner within a cross-functional environment.

Operations Project Manager

Medical Claims Auditor

Director, Information Technology Governance

Claims Repricing Coordinator

Contract Administrator

Stop Loss Sales Support Specialist