TPA Operations Supervisor (Healthtech)

TL;DR

TPA Operations Supervisor (Healthtech): Leading daily TPA operations including appeals and correspondence for a health technology platform with an accent on operational efficiency and client support. Focus on streamlining work processes, managing claims escalations, and developing standard operating procedures.

Location: Remote or Hybrid (Must be based in the United States, with office locations in Denver, CO and New York, NY)

Salary: $100,000 - $125,000 USD

Company

Enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including PBM and an Enterprise Health Platform.

What you will do

• Oversee daily TPA operations including appeals, correspondence, and training.
• Collaborate with product and development teams to drive operational efficiency and support client needs.
• Analyze and respond to first-level appeals within legal timeframes.
• Support the Customer Care and medical Claims Departments by delegating and resolving escalations.
• Develop standard policies, procedures, and training materials for cross-functional teams.
• Track and maintain quality levels and production SLA response times.

Requirements

• 5+ years of TPA or health plan experience in Claims Adjudication, Appeals, or Plan Design.
• Ability to interpret multiple client plan designs and Summary Plan Descriptions (SPDs).
• Based in the United States.
• Exceptional written and verbal communication skills.
• Ability to work in a high-paced, deadline-driven environment with strong attention to detail.

Nice to have

• Bachelor’s degree.
• Knowledge of CPT, HCPCS, ICD-10, and CDT coding.
• Experience with Cigna Payer Solutions.
• Experience with Pharmacy, Dental, or Vision plans.
• Familiarity with self-funded plans, Medicare/Government programs, and ERISA.
• Experience in No Surprise Act Open Negotiation Appeals.

Culture & Benefits

• Opportunity to influence operational best practices in the healthcare space.
• Collaborative environment working with cross-functional stakeholder teams.
• Focus on rebuilding trust in the U.S. healthcare infrastructure.
• Commitment to a diverse and inclusive workplace with equal employment opportunities.