Senior Business Process Manager

Senior Business Process Manager

Position Summary

The Senior Business Process Manager is responsible for ensuring the accuracy, timeliness, and completeness of all claim and policy data transmitted from the TPA to carrier partners.

This role serves as the single point of ownership for carrier data quality issues, accountable for driving resolution both internally across departments and externally with carrier partners. The position owns the monthly carrier error‑reporting cycle, enforces cross‑department accountability for corrections, and leads continuous improvement efforts to eliminate recurring data issues across Claims, Policy Setup, IT/EDI, Account Management, and Finance.

This position is both hands‑on and governance‑focused, ensuring strong processes, clear ownership, and predictable execution across the TPA.

Authority & Accountability

This role is empowered to act as the escalation and enforcement point for carrier data issues.

• Acts as the final escalation point for unresolved carrier data quality issues
• Assigns ownership and deadlines across Claims, Policy Setup, IT/EDI, Account Management, and Finance
• Holds teams accountable for timely corrections and root‑cause remediation
• Represents the TPA in carrier discussions related to data accuracy, corrections, SLAs, and reporting standards

Key Responsibilities

Carrier Reporting & Error Management

• Own the monthly carrier error‑reporting process from intake through correction and resubmission
• Review, categorize, and assign errors to responsible departments with clear due dates
• Track progress and ensure corrections meet carrier SLAs
• Validate corrected transactions and coordinate resubmission with IT/EDI
• Serve as the primary liaison with carrier partners for data quality issues
• Proactively communicate trends, remediation plans, and resolution timelines to carriers
• Resolve disputes related to data accuracy, responsibility, or reporting expectations

Policy Setup & Renewal Data Quality

• Oversee accuracy of policy setup, renewals, and mid‑term changes
• Identify, assign to proper team and resolve class code errors, exposure discrepancies, and policy data gaps
• Ensure policy data is complete and properly structured for claim‑level reporting
• Maintain documentation of carrier‑specific policy and reporting requirements
• Partner with Account Management leadership to reinforce data standards and expectations

Claims Data Quality & Operational Support

• Identify claim‑level data issues, including:
• Missing or incorrect Date of Injury
• Incorrect jurisdiction
• Coverage coding errors
• Claim‑finding and linkage issues
• Partner with Claims leadership to reinforce data standards and expectations
• Provide targeted training, documentation, or job aids when recurring issues emerge

Cross‑Functional Coordination

• Work closely with:
• Claims Operations to correct and prevent claim‑level errors
• Account Management to align carrier expectations and client commitments
• IT/EDI to improve system validations, reporting logic, and automation
• Finance to ensure accurate financial and transactional reporting
• Facilitate monthly cross‑department carrier error review meetings
• Drive decisions and resolution, not just discussion

Enterprise Data Governance & Continuous Improvement

• Maintain a centralized error‑tracking system with clear ownership and deadlines
• Analyze error trends and lead root‑cause elimination efforts
• Develop, document, and enforce SOPs for policy setup, renewals, and claim data entry
• Partner with IT to automate controls and reduce manual corrections
• Build dashboards summarizing error volume, root causes, SLA performance, and recurrence

#LI-Hybrid

Qualifications:

• 5-10 years of experience in a TPA environment (Claims, Policy Setup, EDI, Account Management, or Operations)
• Strong understanding of TPA‑to‑carrier reporting requirements and dependencies
• Experience with EDI, data validation, or claim transaction reporting preferred
• Proven ability to manage cross‑functional workflows and drive accountability
• Excellent analytical, organizational, and communication skills