Program Manager - TPA Services & Call Center Operations

Program Manager - TPA Services & Call Center Operations

Location: [Remote]
Department: Operations/Client Services
Employment Type: Full-Time

Position Overview:

We are seeking an experienced Program Manager to oversee the end-to-end delivery of Third-Party Administrator (TPA) services and Call Center operations. The ideal candidate will have a strong background in managing TPA services and be able to ensure service excellence, maintain client relationships, and adhere to governance frameworks. This is a highly strategic role, focused on driving high-quality service delivery, achieving Service Level Agreements (SLAs), and ensuring smooth operational execution.

Key Responsibilities:

1. TPA Services Management:
   • Lead the delivery of Third-Party Administrator (TPA) services, overseeing onshore call center operations and offshore TPA service delivery.
   • Develop, implement, and optimize processes and workflows related to TPA services, including claims management, member enrollments, provider payments, and other administrative functions.
   • Establish and ensure adherence to operational workflows, ensuring services meet agreed quality standards and compliance requirements (HIPAA, CMS, etc.).
   • Ensure operations are run to support / manage as per CMS regulations.
2. Call Center Operations Oversight:
   • Manage the onshore call center operations, including staffing, training, performance management, and quality assurance (QA).
   • Ensure that the call center is fully equipped to handle multilingual support, including TTY/TDD enablement, and meets CMS compliance standards.
   • Monitor and drive performance metrics, ensuring that key performance indicators (KPIs) such as average handle time (AHT), first call resolution (FCR), call abandonment rates, and customer satisfaction (CSAT) are consistently achieved.
3. Service Levels and Client Engagement:
   • Own the Service Level Agreement (SLA) management process, ensuring the delivery of services within agreed-upon SLAs.
   • Regularly review performance reports and collaborate with the client to ensure service expectations are met and exceeded.
   • Lead client-facing meetings, reporting on operational performance, service delivery status, and continuous improvement initiatives.
   • Build and maintain strong relationships with clients, ensuring satisfaction with service delivery, issue resolution, and overall performance.
4. Governance and Continuous Improvement:
   • Develop and execute a governance framework to ensure accountability, transparency, and adherence to contractual commitments across all service areas.
   • Drive continuous improvement initiatives across the onshore and offshore teams to enhance service quality, efficiency, and cost-effectiveness.
   • Ensure that appropriate risk management and compliance frameworks are in place to mitigate operational risks and maintain regulatory standards.
   • Develop and implement training programs to ensure all agents are equipped with the necessary skills to deliver exceptional service while adhering to client requirements and industry regulations.
5. Team Leadership and Collaboration:
   • Lead, mentor, and motivate a cross-functional team of TPA service delivery leads, call center managers, and quality assurance staff.
   • Promote a culture of collaboration between onshore and offshore teams, ensuring clear communication, effective problem-solving, and continuous knowledge sharing.
   • Ensure that all teams are aligned with the program s goals, values, and service excellence standards.

Required Qualifications:

• Bachelor s degree in business administration, Healthcare Administration, Operations Management.
• 12+ years of experience managing TPA services, in the healthcare or insurance industry.
• Experience in handling multilingual support, including TTY/TDD services, and ensuring compliance with CMS regulations.
• Expertise in governance, risk management, and continuous improvement processes in a service delivery context.
• Exceptional leadership skills with a proven ability to lead cross-functional teams and drive operational excellence.
• Experience working in or managing Medicare Advantage, Medicaid, or other government healthcare programs.

Preferred Qualifications:

• Master s degree in business administration, Healthcare Administration, or a related field.
• Familiarity with IVR systems, CRM platforms and call center technologies.
• Certification in project management (e.g., PMP), Lean Six Sigma, or other process improvement methodologies.

Key Competencies:

• Ability to think strategically and drive initiatives that improve service delivery and operational efficiency.
• A customer-centric mindset with a focus on ensuring the highest level of client satisfaction.
• Strong focus on improving operational performance and driving process efficiencies.
• Strong analytical and problem-solving skills, with the ability to resolve complex service delivery challenges.
• Proven ability to lead teams, inspire others, and deliver results in a fast-paced environment.