TPA Manager

Benefits

Additional Information

The TPA Manager is accountable for delivering exceptional service to customers and distribution partners by managing the relationship and performance of the Third-Party Administrator (TPA) responsible for health insurance claims. The role ensures efficient claims processing, regulatory compliance, and a superior customer experience, contributing significantly to the company's strategy of becoming the preferred choice for customers in the Philippines. The TPA Manager oversees the day-to-day management of all TPA activities and transactions, ensuring the operating model remains aligned with business objectives, customer experience goals, and risk management requirements, while actively managing the TPA relationship, monitoring performance, and overseeing all TPA-related interactions and processes. Position Responsibilities: Support the execution of TPA strategies aligned with business objectives. Drive transformation initiatives to enhance customer experience within the TPA's scope of work. Define and monitor KPIs, including SLAs for in-scope transactions, complaint handling, First Call Resolution (FCR), Net Promoter Score (NPS), and metrics related to fraud, waste, and abuse. Establish the strategy for an in-house provider network, as applicable. Provide inputs to initiatives related to provider network development, as needed Manage and oversee TPA operations for both claims and contact center, acting as the primary point of contact for TPA escalations, ensuring compliance with SOPs, monitoring TAT, resolving complex issues, and escalating risks within 24 hours. Review and report financial and non-financial errors by the TPA on a weekly and monthly basis in collaboration with the Health Claims Team. Facilitate Monthly TPA Steering Committee meetings to review challenges, identify improvement areas, and propose solutions. Assist in building an in-house provider network, including recruitment, credentialing, contracting, and onboarding, as required. Establish and maintain quality assurance processes and reporting to ensure service excellence. Analyze feedback and trends to identify service gaps and training needs. Promote a customer-first culture across the TPA team. Support implementation of automation and technology improvements in collaboration with the TPA. Coordinate with internal teams to support system and process enhancements. Lead internal staff supporting TPA operations, providing training on claims and vendor management processes. Foster a culture of continuous improvement, accountability, and customer empathy. Implement career development and succession planning for key roles. Manage the revolving fund and ensure accurate billing and reconciliation of paid claims and TPA fees Monitor cost efficiency and adherence to the budget for staffing, technology, and operations Ensure adherence to internal policies and external regulatory requirements Manage fraud and regulatory risk in line with enterprise standards Work closely with Underwriting, Claims, Distribution, Marketing, Product, and other relevant teams to ensure seamless customer and distribution journeys. Support digital transformation initiatives and enable customer/agent self-service. Required Qualifications: University graduate with at least 3-5 years of solid experience in TPA management, preferably within the healthcare or insurance industry. Familiarity with the latest technological developments, trends, and standards is desirable. Highly motivated and capable of working independently and collaboratively. Proven ability to build and lead high-performance teams within operations and support functions. Strong stakeholder management skills, including interaction with regional functions. When you join our team: We'll empower you to learn and grow the career you want. We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words. As part of our global team, we'll support you in shaping the future you want to see. About Manulife and John Hancock Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html . Manulife is an Equal Opportunity Employer At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age,