Health Plan Operations Leader: TPA & Admin

The Operations Supervisor is responsible for overseeing the daily activities of the Operations Support Specialist team while driving operational excellence across the organization. This role serves as a subject matter expert in health plan administration, TPA operations, and self-funded employer health plans. The Operations Manager ensures operational processes are executed efficiently, supervises team performance and workflow, and leads program-level projects focused on continuous improvement, scalability, and service delivery enhancement. The ideal candidate will possess extensive experience working within a Third-Party Administrator (TPA), health plan, or employer benefits environment and demonstrate the ability to interpret and apply benefits plan documents, including Summary Plan Descriptions (SPDs), plan documents, and related health plan materials Education: Experience: Minimum of 5 years working in Health Plan Benefits Administration 2 Years of Management experience preferred Requirements/Skills: Proven experience in an operations or supervisory role Proficiency in Microsoft office applications; Word, Excel, Outlook, and Teams TPA and Health Plan Administration Experience Ability to understand Health Plan Design Ability to learn and utilize internal applications. Strong interpersonal communication skills. Awareness of internal and external customer needs. Knowledge of insurance, self-funded, and stop loss industry. Self-motivated, and ability to see projects through to execution. Strong trouble shooting and problem-solving skills. Good organizational skills and time management Excellent verbal and written communication skills Ability to handle difficult situations tactfully and diplomatically. Effective problem solving and decision-making skills. Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint) Duties and Responsibilities: Supervise daily operational activities to achieve production or service targets and maintain quality standards. Allocate tasks and resources to team members, balancing workload and skills to meet demand. Provide coaching, training and feedback to staff to improve competence and productivity. Monitor and Analyze workload distribution and ensure timely completion of operational tasks. Provide guidance and quality assurance for system configurations Conduct performance reviews, coaching sessions, and ongoing staff development. Oversee the Issue Tracking Program Manage the Operations Support Specialist Issue Log Ensure Issues are resolved in a timely manner Monitor and analyze issues for trends and provide VP of Operations with suggestions for improvements Work with the Vice President, Operations to oversee the prioritization and execution of mitigation strategies related to high priority/high impact issues. Ongoing Management of Operations Support Specialist Policies and Procedures Develop, revise and operationalize policies and procedures Review and Approve Policies Modified by Operations Support Specialist staff Oversee data integrity initiatives, including data entry accuracy audits, cleanup efforts, and operational improvement projects. Foster a culture of accountability, teamwork, continuous learning, and customer service excellence. Serve as an escalation point for Operations Support Specialist issues and complex client requests. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time, with or without notice. The pay range for this position is $62000.00 to $71000.00 Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. Scope: The Operations Supervisor is responsible for overseeing the daily activities of the Operations Support Specialist team while driving operational excellence across the organization. This role serves as a subject matter expert in health plan administration, TPA operations, and self-funded employer health plans. The Operations Manager ensures operational processes are executed efficiently, supervises team performance and workflow, and leads program-level projects focused on continuous improvement, scalability, and service delivery enhancement. The ideal candidate will possess extensive experience working within a Third-Party Administrator (TPA), health plan, or employer benefits environment and demonstrate the ability to interpret and apply benefits plan documents, including Summary Plan Descriptions (SPDs), plan documents, and related health plan materials Education: HS Diploma required; Bachelor’s degree Preferred Experience: Minimum of 5 years working in Health Plan Benefits Administration 2 Years of Management experience preferred Requirements/Skills: Proven experience in an operations or supervisory role Proficiency in Microsoft office applications; Word, Excel, Outlook, and Teams TPA and Health Plan Administration Experience Ability to understand Health Plan Design Ability to learn and utilize internal applications. Strong interpersonal communication skills. Awareness of internal and external customer needs. Knowledge of insurance, self-funded, and stop loss industry. Self-motivated, and ability to see projects through to execution. Strong trouble shooting and problem-solving skills. Good organizational skills and time management Excellent verbal and written communication skills Ability to handle difficult situations tactfully and diplomatically. Effective problem solving and decision-making skills. Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint) Duties and Responsibilities: Supervise daily operational activities to achieve production or service targets and maintain quality standards. Allocate tasks and resources to team members, balancing workload and skills to meet demand. Provide coaching, training and feedback to staff to improve competence and productivity. Monitor and Analyze workload distribution and ensure timely completion of operational tasks. Provide guidance and quality assurance for system configurations Conduct performance reviews, coaching sessions, and ongoing staff development. Oversee the Issue Tracking Program Manage the Operations Support Specialist Issue Log Ensure Issues are resolved in a timely manner Monitor and analyze issues for trends and provide VP of Operations with suggestions for improvements Work with the Vice President, Operations to oversee the prioritization and execution of mitigation strategies related to high priority/high impact issues. Ongoing Management of Operations Support Specialist Policies and Procedures Develop, revise and operationalize policies and procedures Review and Approve Policies Modified by Operations Support Specialist staff Oversee data integrity initiatives, including data entry accuracy audits, cleanup efforts, and operational improvement projects. Foster a culture of accountability, teamwork, continuous learning, and customer service excellence. Serve as an escalation point for Operations Support Specialist issues and complex client requests. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time, with or without notice. The pay range for this position is $62000.00 to $71000.00 Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. We are an Equal Opportunity Employer including disability/veterans #J-18808-Ljbffr MedWatch, LLC