Director of TPA Relations
Position Summary
The Director of TPA Relations is responsible for overseeing and optimizing the organization’s use of third-party administrators (TPAs). This role ensures that TPAs deliver high-quality, cost-effective administrative services aligned with company objectives. Acting as the internal owner of TPA performance, the Director drives accountability, monitors outcomes, and partners cross-functionally to improve operational efficiency and service delivery.
Essential Functions
Own and manage relationships with TPAs supporting global IPMI, emergency medical assistance, and cost containment programs.
Oversee end-to-end TPA performance, including international claims adjudication, pre-authorizations, case management coordination, and provider payments.
Monitor service delivery against KPIs and SLAs such as turnaround times, accuracy, customer experience, and cost savings outcomes.
Drive cost containment effectiveness by evaluating TPA performance in areas such as medical bill review, network utilization, negotiated discounts, and high-cost case management.
Lead resolution of escalated global claims and assistance cases, particularly complex, high-dollar, or sensitive international situations.
Partner with clinical, operations, provider network, and finance teams to ensure seamless coordination of care and cost management across regions.
Analyze claims and assistance data to identify trends, leakage, fraud/waste/abuse risks, and opportunities for operational and financial improvement.
Ensure TPAs comply with varying international regulatory requirements, policy provisions, and internal standards.
Lead contract oversight, including service scope, performance guarantees, and financial terms; support renegotiations where needed.
Support onboarding, transition, or replacement of TPAs across regions or product lines.
Conduct regular business reviews with TPAs to assess performance, address gaps, and implement continuous improvement initiatives.
Minimum Qualifications
Bachelor’s degree in Business, Healthcare Administration, or related field, or equivalent practical experience.
Advanced degree or specialized certifications are a plus.
8–12+ years of experience in IPMI, global health insurance, international assistance, or travel/expat medical programs.
Direct experience working with TPAs, assistance companies, or global claims administrators from the client side.
Strong understanding of international healthcare systems, cross-border claims, and global provider networks.
Experience with cost containment strategies, including negotiation, bill review, and utilization management.
Proven ability to manage complex vendor relationships and hold partners accountable in a global environment.
Strong analytical, negotiation, and problem-solving skills.
Ability to operate effectively across multiple time zones and cultures.
Key Competencies
Global vendor management & accountability
International claims & assistance operations
Cost containment strategy & execution
Data analysis & performance optimization
Cross-cultural communication
Escalation and crisis management