Auto TPA Manager

Coaction Global•Morristown, NJ

6d•Hybrid

About The Position

At Coaction, we’re a unique mix of leaders, achievers, thinkers, and team players with a high-performance mindset and a diverse skillset. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients. The Co/Action TPA Manager plays a critical role in ensuring that our outsourced claim administration operates efficiently, cost-effectively, and in compliance with all relevant regulations. Effective claim oversight requires strong technical expertise, project management, communication, and problem-solving skills, as well as a deep understanding of the specific services being outsourced. The Co/Action TPA Manager is responsible for overseeing the performance of our panel of third-party administrators. Each TPA manager has responsibility for one or more TPA’s. Oversight includes day-to-day claims management, review of claims for reserve and settlement authority above TPA delegated authority, assurance of regulatory compliance, compliance with our service agreements and claim handling guidelines, meeting of our performance standards, delivering quality services and providing exceptional customer experience.

Responsibilities

TPA Management and Relationship Building Develop and maintain relationships with assigned third-party administrators (TPAs) to ensure smooth collaboration and service delivery. Serve as the primary point of contact between Co/Action and the TPAs. Work with AVP of TPA Management and Legal to negotiate new contracts, and amendments for renewals and service level agreements (SLAs) with TPAs to establish clear expectations and performance metrics. Monitor TPA compliance with contract terms, regulations, and internal policies.
Performance Monitoring and Reporting Track and evaluate TPA performance against established metrics, such as claims processing time (durations), customer service response times, and cost control. Analyze reports generated by TPAs, such as loss runs, financial data, and service level performance. Identify and address any performance gaps or service issues and work with the TPA to implement corrective actions. Regularly report on TPA performance to AVP, highlighting key issues, trends, and improvements.
Risk Management and Compliance Ensure that TPAs are following all relevant legal, regulatory, and industry standards, such as Medicare Reporting. Conduct regular claim audits of TPA activities and documentation to ensure that they are adhering to best practices, contractual obligations and regulatory requirements. Monitor the security and privacy of sensitive data handled by TPAs, ensuring they meet required standards for data protection.
Process Improvement and Efficiency Collaborate with TPAs to identify process improvements that can enhance efficiency, reduce Co/Action costs, or improve service delivery. Support the implementation of any new technologies, systems, or processes that improve the effectiveness of TPA operations. Drive continuous improvement initiatives.
Claims Oversight Oversee the TPA claims management process, ensuring that claims are processed accurately, timely, and in accordance with guidelines. Work with TPAs to resolve disputes or escalated issues related to claims, response times or staffing.
Training and Support Provide and/or support training to TPA employees on Co/Action processes, policies, and expectations (i.e., Subrogation and Recovery, SIU and Fraud, Medicare). Offer ongoing support to TPAs as they handle day-to-day claim handling, troubleshooting any issues that arise and offering guidance as needed. Stay updated on industry trends and educate TPAs on any new regulations, technologies, or best practices.
Budget and Cost Management On a monthly basis review service fee and loss fund invoices from TPAs, ensuring that services rendered are in line with the terms of the contract and budget. Identify opportunities for cost savings and raise these opportunities for possible renegotiation of terms to maximize the value of third-party services.
Escalation and Issue Resolution Resolve complex issues that may arise between Co/Action and assigned TPAs, including conflicts or discrepancies in service delivery. Implement effective strategies for escalation and issue resolution, ensuring timely resolution of problems.
Reporting and Documentation Prepare detailed reports for senior management on TPA performance, issues, and any required actions or decisions. Ensure that all documentation related to TPA contracts, performance reviews, audits, and other oversight activities is organized, accurate, and up to date.
Strategic Planning and Innovation Provide strategic input into the organization’s broader outsourcing strategy, helping identify potential new TPAs or services to improve quality. Stay informed about industry trends and new technologies that may improve Co/Action’s third-party administration strategy or service delivery.