TPA Operations Specialist

ABOUT HUB INTERNATIONAL:

HUB International Limited (HUB) is one of the largest global insurance and employee benefits broker providing a broad array of property casualty risk management life and health employee benefits investment and wealth management products and services. With over 21000 employees in 600 offices throughout North America HUB has grown substantially in part due to our industry leading success in Mergers and Acquisitions.

WHAT WE OFFER YOU:

At HUB we believe in investing in the future of our employees. Our entrepreneurial culture fosters an environment of open feedback and improvement that empowers our people to make the best decisions for our customers and organization. We offer:

• Competitive salaries and benefits offerings

  • Medical/dental/visioninsurance and voluntary insurance options

  • Health Savings Account funding

  • 401k matching program

  • Company paid Life and Short-Term Disability Plans

  • Supplemental Life and Long-Term Disability Options

  • Comprehensive Wellness Program

  • Generous PTO Package - Vacation Holiday Sick and Personal Time Off

• Great work/life balance because thats important for all of us!

• Focus on creating a meaningful environment through employee engagement events.

• The ability to be a part of a motivated winning team with the opportunity to learn from colleagues who are amongst the top talent in the industry!

• Growth potential - HUB is constantly growing and so can your career!

• A rewarding career that helps local businesses in the community

• Strong community support and involvement through HUB Gives

POSITION SUMMARY:

TheTPAOperations Specialist is a critical operational role within our Healthcare Third-Party Administrator (TPA) organization. This positionis responsible fortheaccurateandtimelyexecution of client claims funding activities including weeklycheck register dutiesand multi-line claims invoicing across medical prescription and dental addition the Specialist supports a broad range of TPAdutiesThisrole requires a detail-oriented professional who thrives in a fast-paced deadline-driven healthcare environment.

PRIMARY RESPONSIBILITIES:

Claims Funding & Financial Operations

• Perform the clients weekly check register reporting and funding process requirements.

• Respond to customer inquiriesregardingweekly electronic fund transfers (EFTs) and ACH transactions including vendor reports.

• Ensure thataccuratefunding transmittalsfor medical prescription (Rx) and dental claimsare senttoclients on establishedfundingcycles.This would include detailed check registers and claim reports as requested by a client.

• ReconcileFBOfunding accounts and resolve discrepancies betweenclaimspayments client deposits and issued invoices.

• Monitor funding thresholds and communicate proactively with clientsregardinginsufficient funding or pending shortfalls.Monitor outstanding funding requests toensurefunding isreceivedand checks are releasedtimely.

• Maintainaccuratefinancial records and documentation in support of audit and compliance requirements.

BenefitPlan Configuration & Adjudication System Administration

• Build and configure benefit plan structures within the claims adjudication platform including coverage tiers deductibles copays coinsurance and out-of-pocket limits.

• Translate client Summary Plan Descriptions (SPDs) and benefit summaries intoaccuratesystem configurations.

• Perform testing and validation of new or modified benefit plan configurations prior togo-liveand ongoing basis.

• Utilize CRM for allplan-build documentation and change logs to support compliance auditing and clientreporting for account manager access.

• Utilize CRM for implementation of new clientswith account management and implementation teams during new client onboarding and annual open enrollment periods.

• Assistin the configuration ofprovider networks andbenefithierarchy structures within the adjudication system to ensureaccurateclaims routing and processingbyplandesign. This would include Baseload rule implementations.

• Assist on 1099 annualdocumentation requests.

General & Administrative Duties

• Respond to CRM Tasks Assignedin a timely manner.

• Contribute to process improvement initiatives to enhance accuracy efficiency and client satisfaction.

• Assistwith special projects and cross-functionalinitiatives asassigned by management.

• Adhere to all HIPAA privacy and security regulations governing the handling of Protected Health Information (PHI).

SECONDARY / BACKUP RESPONSIBILITIES:

The following duties are performedas assigned bythe Directorof Technology and Director of Claims Operationson an as-needed or backup basis providing operational continuity and cross-functional support:

Client Eligibility Management

• Assistin theprocessmember eligibility additions terminations and changes within the claims adjudication systemin accordance withclient instructions and regulatory timelines.as needed.

SFTP & Secure File Operations

• Back up and assist -Perform scheduled and ad-hoc SFTP file transfers including eligibility feeds claims data remittance files and reporting outputs.

• Monitor fileerror reportsandassistin resolvingerrors. Discuss with EDI Director as needed to completetimely.

• Assistas needed in maintainingSFTP directory structures access credentials and transmission schedules in coordination withEDIDirector.

MINIMUM QUALIFICATIONS:

Education

• Associates degree in Business Administration Finance Health Information Management ora relatedfield.

• Bachelors degree preferred.

Experience

• Minimum 2 years of experience in a healthcare TPA managed care or health insurance operations environment.

• Demonstrated experience with claims fundingbenefit plan building in claims adjudication systemandhealthcare billing and invoicing.

• Familiarity with claims adjudication systems (e.g.JavelinaHealthpac AS400) preferred.

• Experience with benefit plan configuration or enrollment administration is highly desirable.

Knowledge Skills & Abilities

• Strong understanding of self-funded health plan structures including medical Rx and dental benefit lines.

• Proficiencywith SFTP clients and secure file transmission protocols.

• High degree of accuracy and attention to detail in financial and data entry tasks.

• Ability to manage multiple priorities and meet recurring deadlines in a dynamic environment.

• Proficiencywith Microsoft Office Suite particularly Excel (pivot tables VLOOKUP data validation).

• Working knowledge of HIPAA regulations and healthcare data privacy requirements.

• Strong written and verbal communication skills for client-facing interactions.

PREFERRED QUALIFICATIONS:

• Extensive knowledgebaseinthe overall operations of a healthcare TPA.

• Experience with EDI file formats () used in healthcare data exchange.

• Familiarity with pharmacy benefit manager (PBM) interfaces and Rx claims processing.

• Priorexposure to dental claims adjudication or dental benefit plan administration.

WORKING CONDITIONS:

• Standard officeenvironment

• Regular business hours with occasional need to work outside standard hours during month-end open enrollment or client go-live periods.

• Sedentary work with extended periods of computer use.