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POSITION SUMMARY
The Director of TPA Relations is responsible for overseeing and optimizing the organization’s use of third-party administrators (TPAs). This role ensures that TPAs deliver high-quality, cost-effective administrative services aligned with company objectives. Acting as the internal owner of TPA performance, the Director drives accountability, monitors outcomes, and partners cross-functionally to improve operational efficiency and service delivery.
ESSENTIAL FUNCTIONS
Key Responsibilities:
- Own and manage relationships with TPAs supporting global IPMI, emergency medical assistance, and cost containment programs.
- Oversee end-to-end TPA performance, including international claims adjudication, pre-authorizations, case management coordination, and provider payments.
- Monitor service delivery against KPIs and SLAs such as turnaround times, accuracy, customer experience, and cost savings outcomes.
- Drive cost containment effectiveness by evaluating TPA performance in areas such as medical bill review, network utilization, negotiated discounts, and high-cost case management.
- Lead resolution of escalated global claims and assistance cases, particularly complex, high-dollar, or sensitive international situations.
- Partner with clinical, operations, provider network, and finance teams to ensure seamless coordination of care and cost management across regions.
- Analyze claims and assistance data to identify trends, leakage, fraud/waste/abuse risks, and opportunities for operational and financial improvement.
- Ensure TPAs comply with varying international regulatory requirements, policy provisions, and internal standards.
- Lead contract oversight, including service scope, performance guarantees, and financial terms; support renegotiations where needed.
- Support onboarding, transition, or replacement of TPAs across regions or product lines.
- Conduct regular business reviews with TPAs to assess performance, address gaps, and implement continuous improvement initiatives.
MINIMUM QUALIFICATIONS
- Bachelor’s degree in Business, Healthcare Administration, or related field, or equivalent practical experience. Advanced degree or specialized certifications are a plus.
- 8–12+ years of experience in IPMI, global health insurance, international assistance, or travel/expat medical programs.
- Direct experience working with TPAs, assistance companies, or global claims administrators from the client side.
- Strong understanding of international healthcare systems, cross-border claims, and global provider networks.
- Experience with cost containment strategies, including negotiation, bill review, and utilization management.
- Proven ability to manage complex vendor relationships and hold partners accountable in a global environment.
- Strong analytical, negotiation, and problem-solving skills.
- Ability to operate effectively across multiple time zones and cultures.
Key Competencies:
- Global vendor management & accountability
- International claims & assistance operations
- Cost containment strategy & execution
- Data analysis & performance optimization
- Cross-cultural communication
- Escalation and crisis management
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