Analysis Skills, Best Practices, Claims Management, Claims Processing, Communication Skills, Customer Relations, Customer Support/Service, Detail Oriented, Health Insurance, Healthcare Providers, Industry Standards, Insurance Regulations, Interpersonal Skills, Maintain Compliance, Microsoft Office, Organizational Skills, Performance Metrics, Problem Solving Skills, Process Improvement, Regulations, Regulatory Compliance, Resolve Customer Issues, Risk Management, Service Delivery, Service Level Agreement (SLA), Status Reports, Time Management, Trend Analysis
Job Title: TPA Account Administrator
Department: TPA Operations
Reports To: VP of TPA Operations
Location: Louisville, KY - Remote Possible
Job Type: Full-Time
Position Summary:
The TPA Account Administrator plays a critical role in managing healthcare insurance claims and ensuring seamless coordination between clients, providers, and third-party administrators. This position requires strong analytical skills, excellent communication, and organizational abilities to maintain compliance, resolve issues, and enhance service delivery.
Key Responsibilities:
1. Claims Management & Processing
- Accurately process and manage healthcare insurance claims from submission to resolution.
- Review and validate claim documents for compliance with policy terms and regulatory standards.
- Investigate and resolve discrepancies or issues related to claims processing.
- Ensure timely and efficient handling of claims to meet service level agreements (SLAs).
2. Client & Provider Coordination
- Act as the primary liaison between clients, healthcare providers, and insurance carriers.
- Facilitate communication to ensure smooth claims approval and resolution of inquiries
- Provide exceptional customer service by addressing patient and client questions promptly and professionally.
3. Compliance & Regulatory Oversight
- Maintain up-to-date knowledge of healthcare policies, insurance regulations, and TPA guidelines.
- Ensure all claims and processes adhere to federal, state, and industry compliance standards
- Implement best practices to minimize compliance risks and audit findings.
4. Reporting & Process Improvement
- Generate and analyze reports on claims status, trends, and performance metrics.
- Collaborate with internal teams to identify opportunities for process optimization and improved service delivery.
- Support data-driven decision-making through accurate reporting and insights.
Qualifications
- Minimum of 2 years of experience in TPA operations or healthcare insurance sector.
- Strong understanding of healthcare policies, insurance regulations, and claims processing workflows.
- Excellent communication and interpersonal skills with a customer-focused approach.
- Exceptional problem-solving abilities and keen attention to detail.
- Proficiency in Microsoft Office Suite and claims management software.
Core Skills
- Claims Processing
- Customer Service
- Problem-Solving
- Insurance Regulations
- Microsoft Office
- Claims Management Software
- Communication
- Attention to Detail
T
THE LEGACY BENEFITS GROUP CORP