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 21,000 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/vision insurance 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 that’s 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:

The TPA Operations Specialist is a critical operational role within our Healthcare Third-Party Administrator (TPA) organization. This position is responsible for the accurate and timely execution of client claims funding activities, including weekly check register duties and multi-line claims invoicing across medical, prescription, and dental benefits. In addition, the Specialist supports a broad range of TPA duties, This role requires a detail-oriented professional who thrives in a fast-paced, deadline-driven healthcare environment. 

PRIMARY RESPONSIBILITIES:

Claims Funding & Financial Operations 

• Perform the client's weekly check register, reporting, and funding process requirements. 

• Respond to customer inquiries regarding weekly electronic fund transfers (EFTs) and ACH transactions, including vendor reports.  

• Ensure that accurate funding transmittals for medical, prescription (Rx), and dental claims are sent to clients on established funding cycles. This would include detailed check registers and claim reports as requested by a client.  

• Reconcile FBO funding accounts and resolve discrepancies between claims payments, client deposits, and issued invoices. 

• Monitor funding thresholds and communicate proactively with clients regarding insufficient funding or pending shortfalls. Monitor outstanding funding requests to ensure funding is received and checks are released timely.  

• Maintain accurate financial records and documentation in support of audit and compliance requirements. 

Benefit Plan 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 into accurate system configurations. 

• Perform testing and validation of new or modified benefit plan configurations prior to go-live and ongoing basis.  

• Utilize CRM for all plan-build documentation and change logs to support compliance, auditing, and client reporting for account manager access.  

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

• Assist in the configuration of provider networks and benefit hierarchy structures within the adjudication system to ensure accurate claims routing and processing by plan design. This would include Baseload rule implementations. 

• Assist on 1099 annual documentation requests.  

General & Administrative Duties 

• Respond to CRM Tasks Assigned in a timely manner.  

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

• Assist with special projects and cross-functional initiatives as assigned 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 performed as assigned by the  Director of Technology and Director of Claims Operations on an as-needed or backup basis, providing operational continuity and cross-functional support: 

Client Eligibility Management 

• Assist in the process member eligibility additions, terminations, and changes within the claims adjudication system in accordance with client 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 file error reports and assist in resolving errors. Discuss with EDI Director as needed to complete timely.    

• Assist as needed in maintaining SFTP directory structures, access credentials, and transmission schedules in coordination with EDI Director. 

MINIMUM QUALIFICATIONS:

Education 

• Associate’s degree in Business Administration, Finance, Health Information Management, or a related field required. 

• Bachelor’s degree preferred. 

Experience 

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

• Demonstrated experience with claims funding, benefit plan building in claims adjudication system, and healthcare billing and invoicing. 

• Familiarity with claims adjudication systems (e.g., Javelina, Healthpac, 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. 

• Proficiency with 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. 

• Proficiency with 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 knowledge base in the overall operations of a healthcare TPA. 

• Experience with EDI file formats (834, 837, 835) used in healthcare data exchange. 

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

• Prior exposure to dental claims adjudication or dental benefit plan administration. 

WORKING CONDITIONS:

• Standard office environment

• 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.