We are seeking a detail-oriented and proactive oversee and manage a team handling third-party administration services. This role is responsible for ensuring accurate and timely processing of claims, coordination with insurers and clients, compliance with policies, and maintaining high customer satisfaction standards.
Lead and supervise a team of TPA associates to ensure efficient day-to-day operations.
Monitor workload distribution, productivity, and performance metrics.
Ensure accurate and timely processing of claims, pre-authorizations, and reimbursements.
Serve as an escalation point for complex or disputed claims and resolve issues promptly.
Maintain strong communication with insurers, hospitals, clients, and internal departments.
Conduct training and mentoring sessions for team members to improve performance and process adherence.
Ensure compliance with regulatory requirements, company policies, and SLAs.
Prepare and submit regular reports on operational metrics, team performance, and process improvements.
Participate in audits and implement corrective actions when needed.
Drive continuous process improvement initiatives.
Bachelor’s degree in any discipline (Healthcare or Business preferred).
5+ years of experience in TPA operations, with at least 1–2 years in a team leadership role.
Strong knowledge of health insurance claims processing, policy terms, and regulatory compliance.
Excellent communication, leadership, and problem-solving skills.
Proficient in MS Office and claims management systems.
Ability to manage high-volume workloads and meet tight deadlines.