TPA Operations Associate

Judi Health•Charlotte, NC

1d•Hybrid

About The Position

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Its Unified Claims Processing architecture brings pharmacy and medical benefit administration together on a secure platform. The company aims to improve price transparency, operational efficiency, and healthcare service delivery. The TPA Operations Associate supports the daily operations of Judi Health’s TPA team, providing comprehensive medical, dental, and vision support. The role handles correspondence and escalations, collaborates with internal teams, helps improve operational processes, and contributes to training and procedural materials. The position is hybrid, with three days in an office in Charlotte, Denver, or New York City.

Requirements

Bachelor’s degree preferred, or an equivalent combination of education and work experience.
At least 2 years of TPA or health plan experience in claims adjudication, appeals, or another applicable department.
Ability to interpret multiple client plan designs and SPDs.
Exceptional written and verbal communication skills.
Tremendous attention to detail and ability to shift priorities easily in a fast-paced, deadline-driven environment.

Nice To Haves

Knowledge of CPT, HCPCS, ICD-10, or CDT coding.
At least 1 year of experience with Cigna Payer Solutions.
At least 1 year of experience with Aetna Signature Administrators.
Pharmacy, dental, or vision experience.
Experience with self-funded plans, Medicare or government programs, and ERISA.

Responsibilities

Collaborate with product and development teams and other stakeholders to ensure Judi enhancements improve operational efficiency and support ongoing client needs.
Handle incoming correspondence through fax, email, and mail workstreams.
Provide daily support to the Customer Care team, including assisting with and redirecting escalations.
Suggest ways to streamline daily operational work processes and systems to improve efficiency and quality.
Work with the Claims Department, including handling and redirecting escalated issues, and serve as a subject matter resource for the Judi system and claims processing.
Identify, troubleshoot, and promptly escalate operational discrepancies to avoid care disruption.
Contribute to standard policies and procedures and training materials, and provide education and training presentations to cross-functional teams.
Maintain acceptable quality levels and production SLA response times.
Partner with internal teams during client go-lives and troubleshoot operational discrepancies, errors, and problems.
Support general business or team needs as assigned.
Adhere to the Judi Health Code of Conduct and report non-compliance.