Step into a high-impact operations leadership role where you’ll help shape the day-to-day performance of a growing Third-Party Administrator (TPA) . This position owns the operational engine behind the health plan—ensuring members, clients, providers, and partners receive a consistently excellent experience. You’ll lead teams and workflows across claims, eligibility, member services, provider support, implementation, reporting, and vendor coordination , with a mandate to improve processes, strengthen accountability, and build scalable operations—while still being willing to get into the details when needed.

This is a true player-coach opportunity: you’ll lead (managing a small team of 1–2 people ) while staying hands-on in the work—especially around vendor performance, service delivery, and continuous improvement. We’re looking for someone who is solution-oriented, collaborative, and known for finishing what they start—a “ completion addict ” who brings integrity and a service-first mindset to every interaction.

Responsibilities

• Lead day-to-day TPA operations across claims, eligibility/enrollment, member services, provider support, implementation, reporting, and operational escalations.
• Set and manage performance by defining service standards, turnaround times, and KPIs—then using data to improve accuracy, timeliness, and the member/client experience.
• Own complex issue resolution (claims, provider payment, eligibility discrepancies, configuration/network/PBM/stop-loss coordination) and ensure problems are driven through to closure.
• Build scalable infrastructure by documenting policies/procedures, tightening controls and audit readiness, and holding vendors/partners accountable to service expectations.

Candidate Requirements

• 7+ years in healthcare administration/operations (TPA, self-funded employer plans, health insurance, or similar) with 3+ years leading people or operational functions .
• Strong working knowledge of self-funded plan operations , including medical claims administration , eligibility, provider networks, PBMs, stop-loss, and healthcare payment workflows.
• Proven ability to design/improve processes and manage complex workflows, escalations, and cross-functional partner coordination.
• Strong communicator and problem-solver who can operate in an evolving, entrepreneurial environment —balancing strategic improvement with hands-on execution.

Preferred (nice to have)

• Direct TPA experience; claims-adjudication platforms and benefit configuration
• Stop-loss reporting / high-dollar claim management; new plan implementations
• Experience scaling operations and managing vendor ecosystems (networks, PBMs, cost-containment, tech)

Salary $100,000-$125,000/year