Remote TPA Core Services Lead – Requirements & Testing

General Dynamics Information Technology; United States; On-site; USD 113,000 - 138,000; Full time

Job summary

General Dynamics Information Technology is seeking a Business Process Manager to lead end-to-end process governance across eligibility, claims, and member services. The role involves creating SOPs, workflow maps and readiness frameworks, coordinating cross-functional teams, and ensuring compliance with HIPAA and federal requirements.

Responsibilities include governing end-to-end processes for eligibility operations, provider management, payments, and appeals, with a focus on measurable

Qualifications

• Bachelor's degree required.
• 5+ years of related experience.
• Security clearance level MBT2.
• Strong understanding of healthcare operational workflows (eligibility, provider management, claims, payments, appeals).
• Experience developing SOPs, process maps, BPMN artifacts, governance documents and readiness frameworks.

Responsibilities

• Develop, maintain, and govern end-to-end processes for eligibility operations, claims lifecycles, provider management, member services, appeals, payments, and issue resolution.
• Establish SOPs, workflow maps, RACI charts, decision trees, and governance structures.
• Oversee readiness activities during Transition-In with staffing models, workflows, dependencies, and controls documented for launch.
• Lead requirements coordination for core operational capabilities across eligibility, claims, provider data, and member engagement.
• Collaborate with Business Analysts to ensure requirements map to real-world needs.
• Maintain traceability between processes, requirements, SOPs, system configuration rules, and testing artifacts; ensure HIPAA and contract compliance.

Skills

Business Processes

Business Process Improvements

Process Analysis

Process Governance

Process Improvements

Education

Bachelor of Arts/Bachelor of Science

Tools

Visio

Lucidchart

Miro

BPMN tools

Job description

General Dynamics Information Technology is seeking a Business Process Manager to lead end-to-end process governance across eligibility, claims, and member services. The role involves creating SOPs, workflow maps and readiness frameworks, coordinating cross-functional teams, and ensuring compliance with HIPAA and federal requirements.

Responsibilities include governing end-to-end processes for eligibility operations, provider management, payments, and appeals, with a focus on measurable