TPA Operations Associate

Judi Health; Charlotte, Denver, New York (NC, CO, NY); Hybride; USD 31 000 - 39 000; Plein temps

Résumé du poste

Judi Health, LLC is seeking a TPA Operations Associate to support medical, dental and vision benefits for our TPA team. You’ll participate in daily operations across correspondence, training and governance, helping to elevate client service and operational excellence in healthcare.

You will collaborate with product, claims and other teams to optimize workflows, handle multi-channel communications, and assist with escalations while maintaining high quality and SLA standards in a fast-paced

Qualifications

• Bachelor’s degree preferred or an equivalent combination of education and work experience.
• 2+ years of TPA/health plan experience in Claims Adjudication, Appeals, or other applicable department needs.
• Ability to interpret multiple client plan designs and SPDs.
• Enhanced knowledge of CPT, HCPCS, ICD-10, CDT coding a plus.
• 1+ years of experience with Cigna Payer Solutions a plus.
• 1+ years of experience with Aetna Signature Administrators a plus.
• Pharmacy, Dental, or Vision experience a plus.
• Self-funded plans, Medicare/Government programs and ERISA experience preferred.
• Demonstrated attention to detail, ability to shift priorities, and work in a fast-paced environment.
• Excellent written and verbal communication skills.

Responsabilités

• Cross-functional collaboration with product/dev and other teams to improve Judi operations.
• Handle incoming correspondence via multiple workstreams (fax, email, mail).
• Support Customer Care team and assist with escalations.
• Suggest improvements to daily processes for efficiency and quality.
• Collaborate with Claims Department and serve as a Judi system subject matter resource.
• Identify and escalate operational discrepancies to prevent care disruption.
• Contribute to standard policies, training materials and cross-team education.
• Maintain quality levels and production SLA response times.
• Partner with teams as clients go live and troubleshoot issues.
• Support general business needs as assigned.

Connaissances

Attention to detail

Communication skills

Fast-paced work

Plan design knowledge

Formation

Bachelor's degree or equivalent

Description du poste

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location : Hybrid 3 days in Charlotte, Denver or NYC office

Position Summary

Join our Judi Health TPA team as a TPA Operations Associate, where you will play a pivotal role in delivering comprehensive medical, dental, and vision support to parties of our TPA team. You will participate in the daily operations of our TPA, including areas such as correspondence, training, and more. This position offers the opportunity to contribute to operational best practices and to a team that is redefining operational excellence in the healthcare space.

Position Responsibilities

• Cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure enhancements to Judi drive operational efficiency and support on-going client needs
• Handle incoming correspondence via multiple workstreams (fax, e-mail, mail)
• Provide daily support to our award-winning Customer Care team, including assisting with and re-directing escalations
• Provide input on ways to streamline the work processes and systems in daily operations to create efficiency and quality outcomes
• Work collaboratively with the Claims Department, including handling and redirecting escalated issues. Serving as a subject matter resource for the Judi system and claims processing
• Identify, troubleshoot, and elevate any operational discrepancies immediately to avoid care disruption
• Contribute to the development of standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams
• Maintain acceptable and appropriate quality levels and production SLA response time
• Partner with internal teams as clients go live and troubleshoot operational discrepancies, errors, and problems
• Support general business or team needs, as assigned

Required Qualifications

• Bachelor’s degree preferred or an equivalent combination of education and work experience
• 2+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs.
• Ability to interpret multiple client plan designs and SPDs
• Enhanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus
• 1+ years of experience with Cigna Payer Solutions a plus
• 1+ years of experience with Aetna Signature Administrators a plus
• Pharmacy, Dental, or Vision experience a plus
• Self-funded plans, Medicare/Government programs and ERISA experience preferred
• Tremendous attention to detail, ability to shift priorities easily, and ability to work in a high-paced, deadline-driven environment.
• Exceptional written and verbal communication skills

New York, NY Salary Range

$27.31 - $34.13 USD

Denver, CO Salary Range

$25 - $31.25 USD

Charlotte, NC Salary Range

$22.69 - $28.37 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Judi Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.