Admin Services Specialist
Job Summary
The TPA Administrative Services Specialist supports Third-Party Administrators, health plans, and self-funded employers by delivering high-quality administrative, customer support, and healthcare operations services. The role requires a detail-oriented and customer-focused professional to handle benefits, claims support, and enrollment while maintaining compliance with healthcare regulations. Team members will receive cross-training across multiple healthcare administrative disciplines.
Responsibilities
- Provide exceptional customer service to members and providers
- Process eligibility, enrollment, and coverage changes
- Support claims administration and prior authorizations
- Maintain accurate documentation and provider directories
Required Skills
- Healthcare administration & medical terminology
- Health insurance & eligibility
- Customer service & communication
- HIPAA compliance & Microsoft Office
Job Details
Position Summary: Seeking a highly motivated and customer-focused TPA Administrative Services Specialist to support Third-Party Administrators (TPAs), health plans, self-funded employers. 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, Health insurance, 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.