TPA Claims Manager

We are seeking a collaborative and detail-oriented TPA Claims Manager to lead our claims processing and system configuration for PACE programs. In this role, you’ll manage and mentor the claims coordinator and system configuration teams, drive operational improvements, and ensure service-level targets and compliance requirements are consistently met. Reporting to the Director of TPA Operations, this role combines technical knowledge, a data-driven approach, and strong interpersonal skills to deliver high-quality service to both internal and external stakeholders.

Key Responsibilities 

• Claims Oversight: Lead end-to-end claims operations, ensuring accuracy, timeliness, and alignment with service-level agreements (SLAs).
• Performance Monitoring: Track and evaluate claims metrics, identifying trends to drive team and process improvements.
• System Enhancement/Configuration: Analyze, design and implement improvements to systems to enhance performance, efficiency and user experience
• Team Development: Support the growth of claims coordinators through training, goal-setting, and continuous feedback.
• Process Optimization: Identify opportunities for automation, standardization, and operational efficiency.
• Compliance & Quality Assurance: Ensure claims processes adhere to internal policies, CMS/state regulations, and client contracts.
• SOP Management: Develop and maintain standard operating procedures (SOPs) and training materials.
• Stakeholder Communication: Communicate decisions clearly and professionally to PACE organizations, providers, and internal teams.
• Collaboration: Partner with internal teams to address client concerns and improve service delivery.
• Leadership & Culture: Facilitate regular team meetings to promote alignment and maintain a collaborative, inclusive team culture.
• Issue Resolution: Support the resolution of escalated issues and challenges encountered by the claims staff.
• Continuous Improvement: Use data to identify operational gaps and recommend strategies to improve accuracy and value delivery.
• Compliance Reporting: Ensure team completion of required training and report any concerns related to fraud, waste, or abuse.

What You Bring:

Required

• 3-5 years of experience in a leadership role within a health plan, insurance company, or third-party administrator
• 3-5 years of hands-on claims processing experience
• 3-5 years of system enhancements/configuration
• Strong knowledge of Medicare, Medicaid, and PACE programs
• Familiarity with healthcare coding and reimbursement (e.g., ICD-10, CPT, HCPCS, DRG, RBRVS, APC)
• Experience interpreting data and using insights to improve team and process performance
• Ability to prioritize and manage multiple tasks in a fast-paced setting
• Strong written and verbal communication skills
• Ability to collaborate with both internal teams and external stakeholders
• Experience drafting or updating departmental policies and procedures

Bonus Points if you have:

• Coursework or formal training in medical terminology
• Experience leading or contributing to process automation or operational improvement initiatives
• Familiarity with claims adjudication systems or health plan administration platforms
• Experience in a PACE or long-term care environment
• Previous involvement in regulatory audits or compliance projects

What We Offer
At Collabrios Health, we’re committed to fostering a workplace that supports your well-being, growth, and ability to make a meaningful impact. Here’s what you can expect when you join our team:

• A connected, virtual-first culture with a collaborative, mission-driven team
• Competitive health benefits, including medical, dental, and vision coverage
• 401(k) with company contribution
• Generous paid time off, including 15 PTO days, 2 floating holidays, and 6 sick days
• Flexibility and trust—we empower our team to manage their schedules and work in ways that support their lives
• Opportunities for learning, mentorship, and professional development
• A value-driven environment where diverse perspectives are welcomed and purpose guides our work

We’re committed to building a diverse and inclusive workplace.

Collabrios is an equal opportunity employer. We welcome candidates from all backgrounds, identities, and experiences. If you’re excited about this role but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyway. You may be the right candidate for this or other roles.