TPA Operations Associate

About the role

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid 3 days in Charlotte, Denver or NYC office

Position Summary

Join our Judi Health TPA team as a TPA Operations Associate, where you will play a pivotal role in delivering comprehensive medical, dental, and vision support to parties of our TPA team. You will participate in the daily operations of our TPA, including areas such as correspondence, training, and more. This position offers the opportunity to contribute to operational best practices and to a team that is redefining operational excellence in the healthcare space.

Position Responsibilities:

Cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure enhancements to Judi drive operational efficiency and support on-going client needs

Handle incoming correspondence via multiple workstreams (fax, e-mail, mail)

Provide daily support to our award-winning Customer Care team, including assisting with and re-directing escalations

Provide input on ways to streamline the work processes and systems in daily operations to create efficiency and quality outcomes

Work collaboratively with the Claims Department, including handling and redirecting escalated issues. Serving as a subject matter resource for the Judi system and claims processing

Identify, troubleshoot, and escalate any operational discrepancies immediately to avoid care disruption

Contribute to the development of standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams

Maintain acceptable and appropriate quality levels and production SLA response time

Partner with internal teams as clients go live and troubleshoot operational discrepancies, errors, and problems

Support general business or team needs, as assigned

Required Qualifications:

Bachelor’s degree preferred or an equivalent combination of education and work experience

2+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs.

Ability to interpret multiple client plan designs and SPDs

Enhanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus

1+ years of experience with Cigna Payer Solutions a plus

1+ years of experience with Aetna Signature Administrators a plus

Pharmacy, Dental, or Vision experience a plus

Self-funded plans, Medicare/Government programs and ERISA experience preferred

Tremendous attention to detail, ability to shift priorities easily, and ability to work in a high-paced, deadline-driven environment.

Exceptional written and verbal communication skills

New York, NY Salary Range $27.31—$34.13 USD

Denver, CO Salary Range $25—$31.25 USD

Charlotte, NC Salary Range $22.69—$28.37 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.