TPA Account Administrator

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