Texas Licensed Health Claims Lead

Job Summary

A company is looking for a Health Plan Claims Lead to ensure claims accuracy and compliance while improving operational efficiency.

Key Responsibilities

• Support service and product expansions by integrating new providers and services
• Inspect claims processing quality and provide feedback to TPA as necessary
• Manage TPA operations and ensure compliance with SLAs and regulatory bodies

Required Qualifications

• Bachelor's degree or 6+ years of relevant healthcare operations experience
• Four years of experience managing healthcare operation teams including claims and billing
• Strong knowledge of ACA/IFP and commercial claim requirements
• Experience in oversight management of TPA operations
• Background in developing and reviewing operational SOPs and business requirement documents