Sr. Director, Third Party Administrator
Who we are
Transcarent is the One Place for health and care. We cut through the complexity, making it easy for people to access high-quality, affordable care. With a personalized app tailored for each Member, an on-demand care team, and a connected ecosystem of high-quality, in-person care and virtual point solutions, Transcarent eliminates the guesswork to confidently guide Members to the right level of care. We take accountability for results – offering at-risk pricing models and transparent impact reporting to align incentives towards measurably better experience, better health, and lower costs. At Transcarent, you will be part of a world-class team, supported by top tier investors like 7wireVentures and General Catalyst, and founded by a mission-driven team committed to transforming the health and care experience for all. We closed on our Series C funding in January 2022, raising our total funding to $298 million and enabling us to respond to the demand for our offering.
Transcarent is committed to growing and empowering a diverse and inclusive community within our company. We believe that a team with diverse lived experiences, working together will strengthen our organization, and our ability to deliver "not just better but different" experiences for our members.
We are looking for teammates to join us in building our company, culture, and Member experience who:
- Put people first, and make decisions with the Member’s best interests in mind
- Are active learners, constantly looking to improve and grow
- Are driven by our mission to measurably improve health and care each day
- Bring the energy needed to transform health and care, and move and adapt rapidly
- Are laser focused on delivering results for Members, and proactively problem solving to get there
About this role
The Director, Third Party Administrator (TPA) will be responsible for planning and executing initiatives related to TPA technical and business connectivity and integration. This role requires a highly resourceful, proactive individual, with excellent communication, leadership, management, and TPA experience. This leader will identify and prioritize market and business needs and work with both TPAs and clients to further Transcarent’s mission and drive business growth. This role is critical in bridging strategic, operational, and technical expertise to improve Transcarent solutions and experiences for members and clients.
What you'll do
- Serve as an internal business/technical subject matter expert and roadmap owner for third-party administrator, clearinghouse, HRIS, health plan, and benefit administration integrations
- Architect near-term and long-term business and resourcing plans for electronic claim processing workflows and automation in partnership with Platform, Provider, Finance, and Billing teams
- Develop and lead business and technical organizational strategy, success metrics, timeline, and roadmap to achieve business strategies and goals
- Drive accountability across organization to execute and deliver on roadmap and success metrics
- Serve as the business relationship owner including driving prioritization, results, and alignment across multiple external business enablement partners
- Own business quality, performance, and outcomes of the third-party administrator, clearinghouse, and related functions of the organization
What we're looking for
- Minimum 10 years of healthcare experience with a third-party administrator
- Master’s degree or higher in a health care or business-related field is preferred
- Strong business, strategy, and leadership acumen
- Excellent communication, leadership, interpersonal and customer service skills
- Proven ability to motivate and empower teams in a matrixed environment
- Comfortable in fast-paced and evolving organizations with a willingness to be flexible and pivot when needed
- Excellent at prioritization, scoping, and documentation skills
- Well-versed in a variety of payment models ranging from FFS, RBP, at-risk, and bundled payments as well as associated setup, management, and administration with providers and health systems
- Knowledge of data architecture for real-time eligibility, enrollment, benefits, cost accumulators, and claims data
- Knowledge of medical and pharmacy benefit and plan design, network requirements, and regulatory & licensure environment
- Experience in stop-loss insurance for self-funded employer group health plans
- Experience with EDI file types including 835/837, UB-O4, and 270/271 eligibility
- Understanding of EOB and Remittance Advice communications setup and management
- Familiarity with SPD and SBC setup and management
Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity.
Salary is just one component of Transcarent's total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.
Our benefits and perks programs include, but are not limited to:
- Competitive medical, dental, and vision coverage
- Competitive 401(k) Plan with a generous company match
- Flexible Time Off/Paid Time Off, 12 paid holidays
- Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
- Mental Health and Wellness benefits
You must be authorized to work in the United States. Depending on the position we may have a preference to a specific location, but are generally open to remote work anywhere in the US.
Transcarent is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!
Research shows that candidates from underrepresented backgrounds often don’t apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we aren’t looking for someone who checks each box on a page; we’re looking for active learners and people who care about disrupting the current health and care with their unique experiences.