TPA

Administrative Services Specialist

Reports To

Operations

Supervisor / Team Lead

Position Summary

is seeking a highly motivated and customer-focused TPA Administrative Services

Specialist to support Third-Party Administrators (TPAs), health plans,

self-funded employers. This role serves as an extension of clients' operations

by delivering high-quality administrative, customer support, and healthcare

operations services across multiple functional areas.

The ideal candidate is detail-oriented, adaptable, and committed to delivering

exceptional service while maintaining compliance with healthcare regulations,

client requirements, and operational performance standards. Team members will

receive cross-training across multiple healthcare administrative disciplines.

Essential Duties and Responsibilities

Provide exceptional customer service to members, providers, employer groups, and

healthcare partners.

Assist members with benefits, eligibility, enrollment, claims status, ID cards, and

general plan inquiries.

Support providers with payment inquiries, demographic updates, credentialing support,

and issue resolution.

Process eligibility, enrollment, terminations, and coverage changes accurately.

Support claims administration activities (non-adjudication).

Coordinate prior authorization and pre-certification support.

Request, organize, and validate medical records and supporting documentation.

Support care management, utilization management, and case management activities.

Maintain provider directories and provider data.

Support employer group administration and benefit changes.

Document all customer interactions accurately.

Utilize payer systems, CRM platforms, and Microsoft Office applications.

Meet productivity, quality, turnaround time, and customer satisfaction goals.

Recommend workflow improvements.

Collaborate with internal teams and client stakeholders.

Participate in training and quality initiatives.

Perform additional healthcare administrative duties as assigned.

Qualifications

Education

High School Diploma or equivalent required.

Associate's or Bachelor's degree preferred.

Experience

2+ years of healthcare administration, customer service, health insurance, or revenue cycle experience.

·TPA,payer or provider experience.

Contact center experience preferred.

Knowledge, Skills and Abilities

Healthcare administration

Medical terminology

Healthinsurance

Eligibility & enrollment

Member and provider services

Claims support

Prior authorization

HIPAA compliance

Microsoft Office

Customer service

Analytical and problem-solving skills

Strong communication

Attention to detail

Key Performance Indicators (KPIs)

Quality Assurance

Productivity

Service Levels

First Contact Resolution

Documentation Accuracy

Schedule Adherence

Attendance

Customer Satisfaction

Turnaround Time

HIPAA Compliance

Core Competencies

Customer Focus

Professionalism

Accountability

Integrity

Teamwork

Adaptability

Critical Thinking

Communication

Continuous Improvement

Working Conditions

Office-based or remote depending on assignment.

Flexible schedules as required.

Prolonged computer use.

Frequent interaction with members, providers, and employer groups.