TPA Operations Supervisor

Judi Health•Denver, CO

About The Position

Join our Judi Health TPA team as a TPA Operations Supervisor, where you will play a pivotal role in delivering comprehensive medical, dental, and vision support to parties of our TPA team. You will lead in overseeing daily operations of our TPA, including areas such as appeals, correspondence, training, and more. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining operational excellence in the healthcare space.

Requirements

Bachelor’s degree preferred
5+ years of TPA / health plan experience in Claims Adjudication, Appeals, Plan Design, or other applicable department needs
Ability to interpret multiple client plan designs and SPDs
Tremendous attention to detail, ability to shift priorities easily and ability to work in a high paced, deadline drive environment.
Exceptional written and verbal communication skills

Nice To Haves

Enhanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus
3+ years of experience with Cigna Payer Solutions a plus
Pharmacy, Dental, or Vision experience a plus
Self-funded plans, Medicare/Government programs and ERISA experience preferred
Experience in No Surprise Act Open Negotiation Appeals a plus

Responsibilities

Drives 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
Manage incoming correspondence via multiple workstreams (fax, e-mail, mail)
Analyze and respond to 1st level appeals within timeframe required by law
Provide daily support to our award-winning Customer Care team, including assisting with and delegating escalations
Make recommendations to streamline the work processes and systems that daily operations to create efficiency and quality outcomes
Provide support to the medical Claims Department, including handling and delegating escalated issues and serving as an SME resource for the Judi system and claims processing
Identify, troubleshoot, and escalate any operational discrepancies immediately to avoid care disruption
Develop standard policies and procedures, training materials, and provide ongoing education and training to internal or external cross-functional teams
Track and maintain acceptable and appropriate quality levels and production SLA response times
Partner with internal teams as clients go live and troubleshoot operational discrepancies, errors, and problems
Support general business or team needs, as assigned
Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance