Job Description

The Role

This role sits within the Health & Benefits Middle Office team and is responsible for leading the operational implementation, governance and service delivery oversight of WTW’s TPA facility programme.In addition to serving as the primary coordination and escalation point among WTW, insurers and TPAs, the role will drive the programme’s success by ensuring smooth client onboarding and insurer transitions, effective vendor governance, high-quality service delivery, and consistent client and member experiences.The successful candidate will play a pivotal role in building a scalable, well-controlled operating framework for the delivery, governance and ongoing management of WTW’s TPA facility programme, while partnering with TPAs, insurers and WTW Front Office (FO) teams to support client onboarding and programme expansion.

Programme Implementation & Client Transition Management

• Partner with the FO and Advisory & Wellbeing teams to identify new and existing clients for onboarding to the TPA facility, across insured, self-funded and auxiliary healthcare programmes.
• Lead the client implementation framework for onboarding, insurer transitions, renewals and the ongoing rollout of the facility programme.
• Develop implementation plans, checklists, workflows and operational documentation to ensure consistent onboarding and clear communication with TPAs and insurers.
• Monitor implementation and renewal milestones, including census submission, policy changes, blackout periods, client-specific requirements and operational readiness
• Ensure client-specific arrangements are implemented accurately, including dedicated service hotlines, special service requirements, escalation protocols, reporting and communication needs.
• Manage implementation risks, dependencies and stakeholder communications to ensure smooth client transitions with minimal disruption to members and HR teams.

TPA, Insurer & Vendor Governance

• Serve as the primary operational relationship manager for appointed TPAs and key coordination point with insurer partners.
• Establish and manage a structured governance framework across TPAs and insurers, including operational reviews, performance reviews and quarterly business reviews.
• Ensure governance meetings are documented with clear actions, owners, target completion dates and follow-up.
• Drive accountability for service performance, issue resolution, agreed deliverables and operational standards.
• Maintain consistency of standards across appointed TPAs to preserve flexibility in switching or rebalancing volume between providers, where required.

Service Performance, SLA & Escalation Management

• Establish, monitor and report on agreed SLAs, turnaround times, service quality indicators and operational performance metrics.
• Review TPA operational reports, including claims turnaround times, hotline responsiveness, member enquiry volumes, provider network utilisation, complaints and escalation trends.
• Conduct regular service performance reviews to identify trends, operational gaps and improvement opportunities.
• Coordinate investigation and resolution of complex service delivery issues, member escalation sand critical incidents
• Ensure corrective action plans are implemented and monitored where service standards are not achieved.
• Produce governance reports, KPI scorecards, dashboards and management updates on operational performance and service outcomes.

Operational Risk, Compliance & FWA Oversight

• Monitor TPA fraud, waste and abuse (FWA) frameworks, reporting processes, investigation protocols and control measures
• Review FWA reports, trends and significant incidents with TPAs, insurers and relevant internal stakeholders
• Support periodic reviews of fraud prevention, detection and escalation measures.
• Work with Compliance, Legal and Risk teams on incident reporting, contractual adherence and operational controls.
• Ensure operational processes remain aligned with contractual, regulatory, risk and client requirements.
• Oversee adherence to data protection, confidentiality and information-security requirements, including appropriate handling, access, retention and escalation of member and client data.
• Support audit and assurance activities by maintaining complete governance records, control evidence, issue logs and remediation tracking.
• Ensure business continuity, disaster recovery and critical-incident arrangements are documented, tested periodically and aligned across TPAs.

Continuous Improvement, Technology & Service Enablement

• Partner with TPAs and insurers to identify opportunities for operational, service and technology improvements.
• Track enhancement roadmaps and implementation progress across TPAs and insurers.
• Support implementation of digital servicing solutions, automation initiatives, reporting enhancements and member engagement capabilities.
• Recommend process improvements to enhance efficiency, scalability, service quality and operational effectiveness.
• Maintain documentation of workflows, operating procedures and governance frameworks.

Stakeholder Management & Programme Expansion

• Partner with FO consultants to support client onboarding, programme expansion and adoption of the TPA facility.
• Serve as the primary escalation contact for FO colleagues on facility-related operational matters.
• Coordinate with MO Claims, Advisory & Wellbeing, Technology, Data Analytics, Compliance, Legal and Risk teams to support effective service delivery.
• Support implementation of new service offerings, wellbeing services, ancillary healthcare services and strategic initiatives where required.
• Coordinate with TPAs and the Advisory & Advisory lead to validate utilisation reports and support the timely and accurate billing of referral or marketing fees.
• Monitor commercial and contractual obligations, including fee arrangements, invoicing dependencies, service credits and renewal or termination requirements, in partnership with relevant internal stakeholders.
• Ensure process, workflow and communication changes are clearly communicated to relevant stakeholders.
• Define and track programme outcomes, including implementation timeliness, SLA attainment, issue-resolution effectiveness, stakeholder satisfaction, operational risk reduction and adoption of the TPA facility.

The Requirements

Education & Professional Qualifications

• Bachelor’s degree in any discipline.
• Professional insurance, healthcare or employee benefits-related qualifications would be advantageous.

Experience

• Minimum 6–10 years of relevant experience in employee benefits, health insurance, healthcare administration, TPA management, insurer operations or service delivery management.
• Proven experience managing third-party service providers, insurers or outsourced operational vendors.
• Demonstrated experience leading onboarding, implementation, transition or operational change programmes.
• Strong track record in vendor governance, SLA management, performance review cadence and remediation.
• Experience handling complex operational escalations and cross-functional stakeholder management.
• Experience establishing governance forums, KPIs, dashboards and operational performance reporting.
• Experience supporting audits, control testing, business continuity planning or data-protection requirements in an outsourced service environment would be advantageous.

Technical Knowledge

• Strong understanding of employee benefits programmes, group medical insurance, claims administration processes, TPA operating models and service delivery governance frameworks.
• Good knowledge of healthcare provider networks, operational risk, service controls and outsourcing governance.
• Familiarity with healthcare servicing platforms, digital claims solutions, reporting dashboards and member servicing technologies would be advantageous.
• Working knowledge of data protection, information security, business continuity and audit requirements relevant to healthcare and outsourced service arrangements.
• Strong proficiency in Microsoft Excel, PowerPoint and Word.

Leadership & Stakeholder Management

• Strong ability to influence and coordinate multiple stakeholders across different organizations.
• Ability to build credibility and trusted relationships with insurers, TPAs and internal teams.
• Strong negotiation, conflict-resolution and stakeholder management skills.
• Ability to operate effectively in a matrix and cross-functional environment.

Operational Excellence

• Strong project management, organizational and execution skills.
• Ability to manage multiple priorities and deliver under tight timelines.
• Strong attention to detail and focus on operational discipline.
• Ability to identify improvement opportunities and implement practical, scalable solutions.

Communication & Problem Solving

• Excellent verbal and written communication skills.
• Strong analytical and critical-thinking abilities.
• Ability to manage ambiguity and navigate complex operational challenges.
• Proactive, solutions-oriented and collaborative working style.

Personal Attributes

• Client-centric mindset with strong focus on service excellence.
• Resilient, adaptable and comfortable working in a fast-paced environment.
• Strong sense of ownership and accountability.
• High level of professionalism, integrity and commercial awareness

Equal Opportunity Employer