TPA Operations Associate

Judi Health•Denver, CO

2d•$23 - $34•Hybrid

About The Position

Join Judi Health’s TPA team as a TPA Operations Associate, providing comprehensive medical, dental, and vision support across the TPA team. The role contributes to daily operations, including correspondence and training, and helps advance operational best practices and excellence in healthcare. The position is hybrid, with three days in an office in Charlotte, Denver, or New York City.

Requirements

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.
Strong attention to detail and ability to shift priorities in a fast-paced, deadline-driven environment.
Exceptional written and verbal communication skills.

Nice To Haves

Bachelor’s degree, or an equivalent combination of education and work experience.
Knowledge of CPT, HCPCS, ICD-10, and 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 the product and development team 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 processes and systems to improve efficiency and quality.
Work collaboratively with the Claims Department, handle and redirect 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 for training and 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, including reporting non-compliance.