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
- 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 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.
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 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 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
- 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
- Associate's degree in Business Administration, Finance, Health Information Management, ora relatedfieldrequired.
- 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,andhealthcare 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.
- 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 (834, 837, 835) 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.
Department Account Management & Service
Required Experience: 2-5 years of relevant experience
Required Travel: Negligible
Required Education: Associate degree (2-year degree)
HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations.
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