TPA Supplemental Products Team Lead (Health Insurance)

Position Summary: We are seeking a talented and detail-oriented Supplemental Products Team Lead to join our team at our rapidly growing Third Party Administrator (TPA). The Supplemental Products Team Lead supports the management, analysis, and optimization of supplemental health products — including gap, hospital indemnity, accident, and critical illness plans. Specifically, the Supplemental Products Team Lead will be responsible for coordinating daily job duties to the analysts as well as reviewing, analyzing, and auditing supplemental products insurance claims to ensure that claims are processed in accordance with plan documents, policies, and industry regulations. Distribute claims to the analysts for daily processing. This includes answering any questions they have and going over key concepts utilized throughout the TPA industry and those specific to supplemental medical plans and benefits. Analyze supplemental products insurance claims submitted by providers, facilities, and claimants to ensure they meet policy criteria. Examine the details of the claim, including medical records, police reports, and other documentation. Determine the coverage provided by the insurance policy and evaluate the claim based on policy terms and conditions. Confirm the accuracy and authenticity of data between claims systems, eligibility feeds, and carrier files as well as all documentation submitted, including investigating potential fraud or discrepancies. Make decisions on whether the claims should be approved, denied, or adjusted, based on a thorough review of the evidence, accident letters received, COB obtained, etc. Review and evaluate claims processed by analysts to ensure accuracy, compliance, adjudication turnaround times, and payment integrity. Additionally, support internal & external audits by providing documentation, reconciliations, and process summaries. Be able to jump in and assist with any tasks or assignments provided by the management team. Adhere to insurance regulations and company policies to ensure all claims are processed in a legal and ethical manner. Other tasks as assigned.

Qualifications: High School diploma is required. Previous experience in supplemental products claims processing, customer service, or a related field preferably in healthcare, insurance, or third-party administration (TPA) environment. Prior experience in a supervisor position would be a plus. Strong attention to detail to accurately assess and process claims. Ability to analyze complex information and make informed decisions. Strong written and verbal communication skills to interact with providers, members, and internal teams. Understanding of insurance terminology, policies, regulations, and EDI file formats. Ability to identify issues, think critically, and solve problems in a timely and efficient manner. Proficiency in using computer systems, claims management software, and basic office software (such as Microsoft Office). Work Schedule & Remote Work Full-time, remote position aligned with U.S. business hours. Flexibility required for critical project deadlines, cross-functional meetings, and occasional travel (0–10%) for team collaboration or vendor engagements. Remote Work Requirements Dedicated home office with reliable, high-speed internet. Secure workspace aligned with HIPAA security standards (device encryption, secure Wi‐Fi, screen privacy). Ability to effectively coordinate and lead projects in a fully remote environment. Security, Privacy & Compliance This position requires adherence to Tres Health's security and privacy policies, including HIPAA compliance. All employees must complete security training and comply with access management protocols.

Physical Requirements: Prolonged periods of sitting and working at a computer. Ability to communicate effectively through video, phone, and written platforms. Ability to effectively use computers, video conferencing tools, and other standard remote work technology. Visual and auditory capabilities suitable for remote work. Ability to occasionally lift up to 15 pounds. Tres Health is committed to ADA compliance and will provide reasonable accommodations to individuals as needed. Employment Status This position is governed by at‐will employment, meaning either the employee or Tres Health may end the employment relationship at any time, with or without cause or notice, as permitted by law. EEO & Reasonable Accommodation Tres Health is an Equal Opportunity Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other protected category. Tres Health provides reasonable accommodations to enable individuals with disabilities to perform the essential functions of the role. This description is not...