TPA Operations Supervisor

Job Summary

A company is looking for a TPA Operations Supervisor to oversee daily operations and enhance operational efficiency within the TPA team.

Key Responsibilities

• Drive cross-functional collaboration to enhance operational efficiency and support client needs
• Manage incoming correspondence and analyze first-level appeals within legal timeframes
• Develop standard policies, procedures, and training materials for internal and external teams

Required Qualifications

• Bachelor's degree preferred
• 5+ years of TPA/health plan experience in relevant areas such as Claims Adjudication or Appeals
• Ability to interpret multiple client plan designs and SPDs
• Enhanced knowledge of CPT, HCPCs, ICD-10, and CDT coding is a plus
• Experience with self-funded plans, Medicare/Government programs, and ERISA preferred