Manager
- Infinite
- 5 - 10 years
- Bengaluru
- 8 months ago
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Job Description
Senior Manager - TPA Services
We are seeking an experienced Senior Manager to lead and manage the end-to-end delivery of Third-Party Administrator (TPA) services for a U.S. client. The ideal candidate will have a strong background in managing TPA operations in the insurance sector, specifically within the U.S. healthcare market. This role will oversee back-office operations, including claims processing, enrollment, disenrollment, and related services, ensuring compliance with CMS guidelines and the highest levels of service delivery.
Key Responsibilities:
We are seeking an experienced Senior Manager to lead and manage the end-to-end delivery of Third-Party Administrator (TPA) services for a U.S. client. The ideal candidate will have a strong background in managing TPA operations in the insurance sector, specifically within the U.S. healthcare market. This role will oversee back-office operations, including claims processing, enrollment, disenrollment, and related services, ensuring compliance with CMS guidelines and the highest levels of service delivery.
Key Responsibilities:
- TPA Back-Office Management :
- Lead and manage the offshore TPA operations , ensuring efficient processing of back-office tasks such as claims adjudication , member enrollments , disenrollments , and premium billing .
- Ensure accurate, timely, and compliant processing of health insurance claims , maintaining adherence to CMS guidelines and client-specific requirements.
- Oversee the processing and reconciliation of enrollment files , claims submission , and premium payment processes .
- Collaborate with onshore teams to align operational goals and ensure smooth integration of offshore and onshore activities.
- Team Leadership :
- Manage a team of back-office service agents, ensuring they are adequately trained, motivated, and delivering high-quality services.
- Monitor team performance against KPIs such as claims processing accuracy, turnaround time (TAT), and SLAs, and take corrective actions when necessary.
- Foster a culture of continuous improvement, setting clear goals and expectations, and ensuring high engagement levels within the team.
- Compliance and CMS Guidelines :
- Ensure the offshore team adheres to CMS regulations, including those around Medicare Advantage and Medicaid services.
- Monitor and ensure compliance with relevant HIPAA and insurance sector guidelines, particularly around data privacy, claim integrity, and member confidentiality.
- Handle any audit processes, ensuring all documentation is properly maintained and aligned with regulatory requirements.
- Quality Control, Training and Process Improvement :
- Establish and monitor quality control standards for all TPA back-office services, ensuring that deliverables meet both client specifications and industry standards.
- Ensure training delivery is timely and accurate for the staff skill enhancement.
- Identify opportunities for operational efficiencies, recommending process improvements to streamline workflows, reduce errors, and enhance overall service delivery.
- Reporting and Client Engagement :
- Provide regular reports to senior leadership and the client regarding performance metrics, service delivery status, and key issues.
- Engage with client teams to understand their evolving needs and ensure that TPA back-office services are aligned with their business goals.
- Act as the key point of contact for any client queries related to offshore back-office operations.
- Bachelor s degree in Business Administration, Healthcare Administration, or a related field.
- 5+ years of experience managing TPA back-office services, preferably in the U.S. healthcare insurance industry.
- Strong understanding of CMS guidelines, including those related to Medicare Advantage, Medicaid, and claims processing.
- Proven experience in managing offshore teams and ensuring seamless collaboration between offshore and onshore operations.
- Knowledge of claims adjudication, enrollment processing, provider payments, and other TPA back-office functions.
- Strong leadership skills with the ability to manage and motivate a diverse team in a fast-paced environment.
- Familiarity with healthcare regulations such as HIPAA, SOC 2, and data privacy standards
- Proven ability to lead a high-performance team, focusing on coaching, mentoring, and motivating staff.
- Skilled in managing client expectations, handling escalations, and ensuring service satisfaction.
- Strong focus on improving operational performance and service quality.
- Ability to analyze data and generate actionable insights for process improvements.
- In-depth knowledge of CMS, HIPAA, and industry regulations.
Job Classification
Industry: IT Services & ConsultingFunctional Area / Department: Customer Success, Service & OperationsRole Category: OperationsRole: Assistant ManagerEmployement Type: Full timeContact Details:
Company: InfiniteLocation(s): Bengaluru+ View Contact
Keyskills: Health insurance Process improvement Reconciliation Billing Back office Healthcare Manager Quality Control Service quality Operations Auditing
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