E.D.I.S. is a Third Party Administrator (TPA) who is in the business of showing employers how to reduce the cost of their group medical plans without reducing benefits. We work alongside our broker partners to find the best package and solution.
We are proud to have a management team with a combined total of more than 350 years in the industry, a sales team with a combined total of more than 45 years of experience, and a staff of 70+ that stands behind the service we provide.
We are committed to walking out of the office each day knowing that we've put forth the best effort to produce the highest quality result possible for each of our clients.
We want to be the TPA whose actions make it clear that we are here to serve you, our partner and our clients. We would be honored if you would trust us with your business.
Meet The Best Leadership Team Around
Chief Operations Officer
President & Success Facilitator
Vice President of Sales
Group Guidance Guru
aka: Compliance and Retention Manager
Front Office Manager
& Marketing Manager
Chief Barketing Officer
Director of Bellyrubs
Director of Trash Relocation
Paw-blic Relations Director
Join Our Team
Employer Driven Insurance Services is all about hiring quality people. We truly believe quality people doing quality work is what allows us to provide a quality result for our clients. We are focused on finding team members who will be with us for the long run, who are going to grow in their talents and advance into positions that truly utilize their strengths. We believe that being part of a successful work family is just one element of a truly happy and balanced life. Because of that belief, we offer medical, dental, vision, matching 401K and paid vacation, holidays and sick time to our full-time employees. To find out if E.D.I.S is the right place for you, submit your resume to email@example.com. We look forward to hearing from you regarding the open positions below:
CLAIM ANALYST/PROCESSOR- Tyler, TX
Job Summary: Processes claims for third party administrator after reviewing carrier EOB and determining benefit allocation by reviewing plan design and schedule of benefits. Reviews carrier and provider information to determine correct adjudication of third party benefit. Uses previous claim processing experience to interpret and understand unusual plan designs and coding procedures to process claims while maintaining high quality levels. Essential Functions: • Reviews carrier EOB and processes claims in accordance with employer benefit plan • Meets or exceeds established goals in relation to productivity and quality metrics. • Completes written communication with outside parties as needed to explain benefit payments and denials. • Researches carrier documents to ensure claim payments are accurate. • Utilizes benefit schedules and resources effectively to support claim payment process. • Works with Customer Service, Benefit Plan Loading and other areas to improve processes and workflows. • Works with IT department to ensure system processes work correctly. • Follows and adheres to all office policies, procedures and practices to enhance claim productivity and quality. • Demonstrates ability to assist team members with complex claims, adjustments and special projects. Competency Requirements: • Excellent organizational skills • Time management skills with focus on prioritizing tasks • Ability to work independently. • Problem solving and decision making experience. • Detail orientation with experience in analyzing data. • Proven interpersonal skills to interact with other areas. • Computer knowledge with skill to navigate Web and locate carrier documents Required Skill / Experience: • Claim processing experience, two years preferred • Knowledge of carrier benefit plans and processes • Excellent communication skills - written and verbal.
Why E.D.I.S is Set Apart From the Rest
· In its first year, E.D.I.S. wrote more than 100 stop loss clients becoming the top TPA in the nation for its stop loss carrier.
· E.D.I.S. ensures that every stop loss, MEC plan it offers includes complete aggregate protection to reduce and limit an employer’s plan liability.
· E.D.I.S. was the first TPA in California to implement solutions to overcome the strict self-funding regulations of SB-161 which requires alternative set up and additional tracking.
· Our EDHP™ program returned more than 2 million in unused claims funds to its clients in 2017 and is on target to surpass that in 2018. Where other stop loss carriers and TPA’s keep a portion of the unused claims fund, E.D.I.S. returns 100% to the employer.
· E.D.I.S. is also committed to returning 100% of any pharmacy rebates received through its EDHP™ program to the client whose member has earned it. This is another area where other TPA’s keep the money, or only pass a small percentage through to its client.
· For no additional charge, E.D.I.S. provides a mobile friendly Online Web Portal, Concierge Service, creation and maintenance of required ERISA documents to include a Summary Plan Description, Plan Document, Summary of Benefits & Coverage, Notice of Material Modification and ACA required notices.