TPA Operations Associate

Capital Rx Inc.; Denver (CO); Híbrido; USD 34.000 - 47.000; Jornada completa

Descripción de la vacante

Judi Health is seeking a TPA Operations Associate to join our hybrid team supporting medical, dental, and vision benefits for clients. You will participate in daily TPA operations, including correspondence, training, and process improvements, helping us deliver exceptional client service.

Ideal candidates have a BA or equivalent, 2+ years in TPA/health plan roles, and a knack for detail, communication, and multitasking in a fast-paced environment.

Formación

• 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.
• 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.

Responsabilidades

• Collaborate cross-functionally with product/dev and stakeholder teams to drive operational efficiency and support client needs.
• Handle incoming correspondence via fax, e-mail, and mail across multiple workstreams.
• Provide daily support to the Customer Care team, including assisting with and redirecting escalations.
• Provide input on workflow improvements to streamline daily operations and improve quality.
• Work with the Claims Department handling escalated issues and act as a subject matter resource for Judi system and claims processing.
• Identify, troubleshoot, and elevate operational discrepancies to avoid care disruption.
• Contribute to development of standard policies, procedures, training materials, and cross-functional education.
• Maintain acceptable quality levels and production SLA response times.
• Partner with internal teams as clients go live and troubleshoot discrepancies, errors and problems.
• Support general business or team needs as assigned.

Conocimientos

Attention to detail

Communication skills

Fast-paced environment

Educación

Bachelor's degree or equivalent

Herramientas

CPT/HCPCS/ICD-10/CDT coding

Descripción del empleo

About Judi Health

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.