Back to Jobs

TPA Operations Supervisor

Remote, USA Full-time Posted 2026-07-01

About reputed company

reputed company is an reputed company technology company providing a comprehensive suite of solutions for employers and health plans, including:

  • reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
  • reputed company™, which offers full-service health benefit reputed company to employers, TPAs, and health plans, and
  • Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company.

Position Summary:

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

Position Responsibilities:

  • Drives 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
  • Manage incoming correspondence reputed company multiple workstreams (fax, e-mail, mail)
  • Analyze and respond to 1st level appeals reputed company timeframe required by law
  • Provide daily support to our award-winning Customer Care team, including assisting with and delegating escalations
  • reputed company recommendations to streamline the work processes and systems that daily operations to create efficiency and quality outcomes
  • Provide support to the medical Claims Department, including handling and delegating escalated issues and serving as an SME resource for the Judi system and claims processing
  • Identify, troubleshoot, and escalate any operational discrepancies immediately to avoid care disruption
  • reputed company standard policies and procedures, training materials, and provide ongoing education and training to internal or external cross-functional teams
  • Track and maintain acceptable and appropriate quality levels and production SLA response times
  • Partner with internal teams as clients go live and troubleshoot operational discrepancies, errors, and problems
  • Support general business or team needs, as assigned
  • Responsible for adherence to the reputed company Code of Conduct including reporting of noncompliance

Minimum Qualifications:

  • Bachelor’s degree preferred
  • 5+ years of TPA / health plan experience in Claims Adjudication, Appeals, Plan Design, 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
  • 3+ years of experience with reputed company Payer Solutions a plus
  • Pharmacy, Dental, or reputed company experience a plus
  • Self-funded plans, Medicare/Government programs and ERISA experience preferred
  • reputed company attention to detail, ability to shift priorities easily and ability to work in a high paced, deadline drive environment.
  • Exceptional written and verbal communication skills
  • Experience in No Surprise Act Open Negotiation Appeals a plus
Salary Range$100,000—$125,000 USD

reputed company are responsible for adherence to the reputed company 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.

reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, 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 reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy.

Apply To This Job

Similar Jobs