Auto TPA Manager

Responsibilities

• TPA Management and Relationship Building
• Develop and maintain relationships with assigned third-party administrators (TPAs) to ensure smooth collaboration and service delivery.
• Serve as the primary point of contact between Co/Action and the TPAs.
• Work with AVP of TPA Management and Legal to negotiate new contracts, amendments for renewals and service level agreements (SLAs) with TPAs to establish clear expectations and performance metrics.
• Monitor TPA compliance with contract terms, regulations, and internal policies.
• Track and evaluate TPA performance against established metrics, such as claims processing time (durations), customer service response times, and cost control.
• Analyze reports generated by TPAs, such as loss runs, financial data, and service level performance.
• Identify and address any performance gaps or service issues and work with the TPA to implement corrective actions.
• Regularly report on TPA performance to AVP, highlighting key issues, trends, and improvements.
• Risk Management and Compliance
• Ensure that TPAs are following all relevant legal, regulatory, and industry standards, such as Medicare Reporting.
• Conduct regular claim audits of TPA activities and documentation to ensure that they are adhering to best practices, contractual obligations and regulatory requirements.
• Monitor the security and privacy of sensitive data handled by TPAs, ensuring they meet required standards for data protection.
• Process Improvement and Efficiency
• Collaborate with TPAs to identify process improvements that can enhance efficiency, reduce Co/Action costs, or improve service delivery.
• Support the implementation of any new technologies, systems, or processes that improve the effectiveness of TPA operations.
• Drive continuous improvement initiatives.
• Claims Oversight
• Oversee the TPA claims management process, ensuring that claims are processed accurately, timely, and in accordance with guidelines.
• Work with TPAs to resolve disputes or escalated issues related to claims, response times or staffing.
• Training and Support
• Provide and/or support training to TPA employees on Co/Action processes, policies, and expectations (i.e., Subrogation and Recovery, SIU and Fraud, Medicare).
• Offer ongoing support to TPAs as they handle day-to-day claim handling, troubleshooting any issues that arise and offering guidance as needed.
• Stay updated on industry trends and educate TPAs on any new regulations, technologies, or best practices.
• Budget and Cost Management
• On a monthly basis review service fee and loss fund invoices from TPAs, ensuring that services rendered are in line with the terms of the contract and budget.
• Identify opportunities for cost savings and raise these opportunities for possible renegotiation of terms to maximize the value of third-party services.
• Escalation and Issue Resolution
• Resolve complex issues that may arise between Co/Action and assigned TPAs, including conflicts or discrepancies in service delivery.
• Implement effective strategies for escalation and issue resolution, ensuring timely resolution of problems.
• Reporting and Documentation
• Prepare detailed reports for senior management on TPA performance, issues, and any required actions or decisions.
• Ensure that all documentation related to TPA contracts, performance reviews, audits, and other oversight activities is organized, accurate, and up to date.
• Strategic Planning and Innovation
• Provide strategic input into the organization’s broader outsourcing strategy, helping identify potential new TPAs or services to improve quality.
• Stay informed about industry trends and new technologies that may improve Co/Action’s third-party administration strategy or service delivery.

Qualifications

• A bachelor's degree in a relevant field (e.g., business, finance, healthcare, etc.)
• Minimum of 5 years of experience in claims management, risk management, or a related field.
• Strong technical expertise, project management, communication, and problem-solving skills.
• A deep understanding of the specific services being outsourced.
• Experience working with third-party administrators (TPAs) and familiarity with industry standards and regulations.
• Ability to manage multiple priorities and deadlines effectively.
• Excellent interpersonal and communication skills, both written and verbal.
• Proficiency in Microsoft Office Suite, including Excel and PowerPoint.
• Knowledge of Medicare Reporting and other relevant regulatory requirements.

Benefits

• Discretionary incentive bonus
• Standard benefits package including paid time off, medical, dental, and retirement

Pay

Salary range specific to this role: $99,000 - $135,000 + discretionary incentive bonus + benefits depends on various factors including, without limitation, individual and organizational performance.

Schedule

This is not a fully remote position. Applicants must sit in our Morristown, NJ office on our hybrid work schedule.