Director of Operations

The Director of Operations will be accountable for the Claims, Claims Acquisition, Enrollment, and Member Advocate teams working with PBA’s leadership team to set the course for PBA’s future. Must be an outgoing business leader who can observe, analyze, and continually improve the operation to ensure it runs as efficiently as possible for PBA's success. This role reports to the COO/Integrator. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsibilities

• LMA (Lead, Manage and support a culture of Accountability) using the EOS model to continually develop future leaders.
• Developing, mentoring, and evaluating Operations staff including, but not limited to, annual reviews and Quarterly Conversations.
• Oversight and accountability of the entire Operations team which includes:
  • Member Advocacy (Customer Service)
  • Claims Acquisition
    • Claims Prep
    • PPO Liaison
    • Provider Maintenance
    • Mail Room
  • Enrollment
  • Claims
    • Claims Processing
    • Training/Auditing
    • Excess stop loss claims
    • Plan Loading
    • Medical Management navigation between PBA and UR Vendors
• Vendor management/documentation
• Strategic Planning: Develop and implement operational strategies that support overall business objectives.
• Process Improvement: Analyze and refine business processes, workflows, and policies to boost efficiency and performance.
• Financial Management: Manage operational budgets, control costs, and monitor financial performance metrics.
• Leadership & Supervision: Lead teams, set guidelines for staff, and foster cross-functional collaboration.
• Performance Monitoring: Track key performance indicators (KPIs), analyze data, and report on operational health to executives.
• Accountability: Holds departments accountable for goals, tracks metrics, ensures follow-through, and drives results.
• Resource Management: Oversee production, inventory, vendor relationships, and resource allocation.
• Reporting department activity to COO/Integrator on a weekly basis.
• Applying observations and feedback to continually improve PBA’s operation.
• Other duties as assigned.

Requirements for this position

• 7+ years managing, coaching, and directing larger teams in a similar service based or claims operation.
• 5+ years managing Third Party Administration Claims processing.
• Ability to travel for quarterly meetings and/or client engagements when necessary.
• Stoploss experience or knowledge a strong plus.
• Javelina claims system experience or knowledge a strong plus.
• Senior level organizational, analytical and accountability skills are necessary.
• Effective verbal and written communications.
• Demonstrated ability to get results through team members and management.
• Adaptability to new concepts and systems.
• Problem solver and critical thinker.
• Open minded with a desire to learn, grow and receive feedback in a welcoming way.
• Must be able to represent PBA’s Core Values and business procedures to vendors, brokers, and clients.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $175,000-$190,000 per year.

Claims Manager - Quality

The Claims Manager- Quality, will be responsible for leading, managing and holding accountability for the claims quality teams as outlined below. This position requires an outgoing business leader who can observe, analyze, and continually improve the claim operation to ensure it runs as efficiently as possible for PBA's success. This role reports to the Chief Operating Officer. Please see below for a more in-depth overview of the daily responsibilities and skills required for this position.

Responsibilities

• Reporting department activity to the COO on a continuous basis.
• Oversight of Claims Quality Supervisors and work activity.
• Ensure claim related Performance Guarantees are met 100% of the time.
• Leading, managing, holding accountable Claim Supervisors and providing ongoing development.
• Evaluation and process improvement of:
  • Coordinated Care Unit
  • COB Team
  • Stop Loss/Excess Unit
  • Plan Loading Unit
  • Audit Unit
  • SPD Reviews/Scrubs
  • Rx Mapping
  • NSA/IDR’s
  • New Vendor Installs
  • Training and Development
• Evaluation of staffing needs to support the workflow.
• Delivering quarterly and annual reviews.
• Responding and escalating when needed, questions posed by direct reports and other staff members needing assistance.
• Participating in the interview process of new staff.
• Evaluation of the ongoing training needs.
• Responding to requests made by other department managers as needed.
• Troubleshooting issues and providing prompt, accurate results.
• Responding to client/broker inquiries as needed.
• All other duties as assigned.

Requirements for this position

• 5+ years managing, supervising, coaching, and directing a similar service based or claims operation.
• 5+ years supporting Third Party Administration Claims processing.
• Stoploss experience or knowledge a strong plus.
• Javelina claims system or VBA claims system experience or knowledge a strong plus.
• Effective verbal and written communications skills necessary to lead and grow all team members while supporting our clients and broker’s needs.
• Demonstrated ability to get results through team members.
• Adaptability to new concepts and systems.
• Problem solver and critical thinker.
• Open minded and desire to learn, grow and receive feedback in a welcoming way.
• Must be able to represent PBA’s Core Values and business procedures to vendors, brokers, and clients.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $85,000-$100,000 annually.

Staff Accountant 1 - Corporate Accounting

The Staff Accountant 1 is responsible for managing premium payments, billing accuracy, and financial recordkeeping while supporting client onboarding and ongoing relationships with clients, brokers, carriers, and vendors. This role performs monthly reconciliations and billing reviews, maintains accurate postings in QuickBooks, supports ACH setup and client outreach, and serves as a key resource for resolving payment, rate, and fee inquiries. The position also provides shared or backup support for accounts payable and refunds and plays an active role in new group implementations to ensure accurate system setup and smooth financial operations. This individual will report to the Accounting Manager- Corporate Accounting. Below is a more detailed overview of daily responsibilities and skills required for this position.

Responsibilities

• Premium Payment Processing & Commissions
  • Process client premium payments accurately and on time.
  • Calculate and issue commission checks to brokers and applicable parties.
  • Research and resolve discrepancies related to premiums or commissions.
• Billing & Billing Oversight
  • Perform monthly billing audits and reviews to ensure accuracy and compliance.
  • Address billing errors, rate issues, and fee inquiries.
  • Coordinate corrections with internal teams, clients, brokers, and carriers as needed.
• Client, Vendor, and Partner Communication
  • Serve as a primary point of contact for clients, brokers, carriers, and vendors regarding billing and payment matters.
  • Respond promptly to vendor inquiries related to missing payments, rates, and fees.
  • Maintain professional and timely email and phone communication.
• Client ACH Setup & Outreach
  • Set up client ACH payment arrangements.
  • Conduct client outreach to obtain required banking information and authorization.
  • Monitor ACH activity and resolve rejected or failed transactions.
• Bank Reconciliations
  • Perform monthly bank reconciliations for both client trust accounts and corporate accounts.
  • Investigate and resolve variances between bank statements and accounting records.
• Accounting System Management
  • Record and maintain accurate financial transactions in QuickBooks.
  • Ensure proper coding and documentation of entries in accordance with accounting standards and company policies.
• Accounts Payable (Shared/Backup Responsibilities)
  • Assist with accounts payable processing as a backup or shared responsibility.
  • Verify invoices, obtain necessary approvals, and ensure timely payments.
• Refund Processing (Shared/Backup Responsibilities)
  • Process client and vendor refunds accurately and in compliance with internal guidelines.
  • Provide backup support for refund-related inquiries and documentation.
• New Group Implementation
  • Participate in client-facing meetings during new group onboarding.
  • Set up new clients across all applicable systems and accounts.
  • Coordinate with internal teams to ensure a smooth implementation and accurate billing setup.
• Other duties as assigned.

Requirements for this position

• Bachelor’s/Associates degree in Accounting, Finance, or a related field (preferred).
• 3–4 years of experience in financial accounting or a similar role.
• Strong knowledge of accounting principles and financial reporting.
• Proficiency in accounting software (QuickBooks).
• Excellent analytical and problem-solving skills.
• High attention to detail and accuracy.
• Strong organizational and time management abilities.
• Effective communication and interpersonal skills.
• Experience with prior claims system (Javelina preferred).
• Experience in third-party benefits administration.
• Knowledge of data analytics tools and Excel modeling.

Location Expectations

• This role requires the employee to be on site 1 day a week at our Oak Brook office (may require additional dates with advance notice)

Benefits and Compensation

• PBA offers a comprehensive benefit package to include medical, dental, vision, life insurance, critical insurance, accident insurance, disability and 401k.
• This role has a compensation range of $50,000-$60,000 per year based on prior experience and knowledge.

Mountain Time (MST) Member Advocate

The Member Advocate is responsible for providing excellent customer service to our members and providers. Primary focus will be supporting those in mountain and central time zones. This position requires strong communication skills, problem solving, and overall client satisfaction. This individual reports to the Member Advocacy Manager. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsible For

• 50+ incoming calls per day to provide quality customer service to callers.
• Developing and maintaining problem solving skills and troubleshooting abilities for the purpose of assisting callers and going the “extra mile” when necessary.
• Accurately identifying callers needs, conducting research and assisting with issue resolution.
• Provide clear communication with focus on empathy and professionalism.
• Referring to any claims or issues that require adjustments, processing, repricing, or other intervention according to guidelines.
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
• Own issues through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
• Responding to portals and all e-mails timely.
• Placing follow-up calls to members and providers, timely.
• Maintaining a working knowledge of plan benefits.
• Suggesting process improvement ideas.
• Presenting problems/trends to Management.
• Performing other duties as assigned to support PBA’s Mission, Vision and Core Values.

Skills Required for this Position

• 2+ years in a customer service-oriented role which required communicating over the phone.
• Maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with customers, clients, co-workers, and management.
• TPA/Insurance Company environment or medical billing office experience preferred.
• Customer focused and adaptable to different personality types.
• Multitask with numerous customer service computer screens.
• Excellent typing skills, clearly documenting call notes.
• Active listener and provide empathy and understanding to callers.
• Strong verbal communication and interpersonal skills.
• Ability to quickly learn and adapt to new concepts/systems.
• Professional and responsible work ethic.
• Ability to interface with various levels of the organization.
• Proficient in Microsoft Office Suite products.

Essential Functions Statement

• This role is a remote role requiring the individual to have a private, dedicated space free from distractions.
• In this position you must be able to exchange accurate information/communication with co-workers, customers and vendors.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $23-$25 per hour

Physical Demands

• This is largely a sedentary role which requires the ability to sit for long periods of time.
• The person in this position constantly operates a computer.
• To perform the physical requirements of the position, the employee must be able to have manual dexterity in his or her hands in order to keyboard; see; hear, talk, sit; and stand.