Auto TPA Manager

At Coaction, the TPA Manager plays a critical role in ensuring that our outsourced claim administration operates efficiently, cost‑effectively, and in compliance with all relevant regulations. The manager oversees the performance of our panel of third‑party administrators (TPAs), ensuring that claims are processed accurately, timely, and in accordance with guidelines.

• Build and maintain relationships with assigned TPAs to ensure smooth collaboration and service delivery. Serve as the primary point of contact between Co/Action and the TPAs. Work with the AVP of TPA Management and Legal to negotiate new contracts and amendments for renewals and service level agreements (SLAs) to establish clear expectations and performance metrics. Monitor TPA compliance with contract terms, regulations, and internal policies.
• Track and evaluate TPA performance against established metrics, such as claims processing time, customer service response times, and cost control. Analyze reports generated by TPAs, such as loss runs and financial data. Identify and address performance gaps or service issues and implement corrective actions. Regularly report on TPA performance to the AVP, highlighting key issues, trends, and improvements.
• Ensure TPAs follow all relevant legal, regulatory, and industry standards, including Medicare reporting. Conduct regular claim audits of TPA activities and documentation to ensure adherence to best practices, contractual obligations, and regulatory requirements. Monitor the security and privacy of sensitive data handled by TPAs.
• Collaborate with TPAs to identify process improvements that enhance efficiency, reduce costs, or improve service delivery. Support the implementation of new technologies, systems, or processes that improve the effectiveness of TPA operations. Drive continuous improvement initiatives.
• Oversee the TPA claims management process, ensuring accurate and timely claims processing. Work with TPAs to resolve disputes or escalated issues related to claims, response times, or staffing.
• Provide or support training to TPA employees on Co/Action processes, policies, and expectations, such as Subrogation and Recovery, SIU and Fraud, and Medicare. Offer ongoing support to TPAs as they handle day‑to‑day claim handling, troubleshoot issues, and provide guidance.
• On a monthly basis review service fee and loss fund invoices from TPAs, ensuring that services are in line with contract and budget terms. Identify opportunities for cost savings and recommend renegotiation of terms to maximize value.
• Resolve complex issues that may arise between Co/Action and assigned TPAs, including conflicts or discrepancies in service delivery. Implement effective strategies for escalation and issue resolution to ensure timely resolution.
• Prepare detailed reports for senior management on TPA performance, issues, and required actions or decisions. Ensure all documentation related to TPA contracts, performance reviews, audits, and oversight activities is accurate and up to date.
• Provide strategic input into the organization’s broader outsourcing strategy, helping identify potential new TPAs or services to improve quality. Stay informed about industry trends, new technologies, and best practices that could enhance Co/Action’s third‑party administration strategy.

Salary: $99,000–$135,000 plus discretionary incentive bonus. Benefits include paid time off, medical, dental, and retirement plans.

Location:

Morristown, New Jersey. This position is not fully remote; employees must work from the Morristown office on a hybrid schedule.

Equal Opportunity

Employer:

Coaction is an Equal Employment Opportunity employer. The company’s policy prohibits discrimination based on race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, or genetic information. Harassment of employees or applicants on any of the protected categories is also prohibited.