TPA Operations Associate

Capital Rx; New York (NY); Hybrid; USD 37,000 - 47,000; Full time

Job summary

Judi Health in New York, NY is hiring a TPA Operations Associate to support medical, dental, and vision processes within our TPA team.

You will handle correspondence, training, and daily operations to improve efficiency and care quality. Prior TPA/claims experience and strong communication skills are required; CPT/HCPCS/ICD-10 knowledge is a plus.

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.
• 1+ years of experience with Cigna Payer Solutions a plus.
• 1+ years of experience with Aetna Signature Administrators a plus.

Responsibilities

• Cross-functional collaboration with product/dev and stakeholder teams to drive operational efficiency.
• Handle incoming correspondence via multiple workstreams (fax, e-mail, mail).
• Provide daily support to Customer Care, including assisting with escalations.

Skills

TPA experience

Claims adjudication

Attention to detail

Communication skills

Healthcare coding knowledge

Education

Bachelor's degree or equivalent

Job description

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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.