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 escalate 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