Counsel-TPA Operations

POSITION SUMMARY

The Counsel - TPA Operations is a hands-on attorney responsible for recurring business-facing legal and regulatory work for the Lodestar TPA. The position performs substantive legal work, manages paralegal or contract-administration resources, and improves existing processes.

Although aligned within Claim Operations, the position supports the Lodestar TPA enterprise. Counsel enables business-led contracting through templates, approved language, guardrails and exception criteria; business leaders retain ownership of customer relationships, commercial negotiations and operating commitments. Counsel coordinates with shared-service and specialty legal resources when needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Legal Advice and Business Partnership

• Provide independent, practical legal advice and distinguish legal or regulatory requirements from commercial considerations.
• Communicate material risk, options and recommended action while preserving business ownership of commercial and operating decisions.

Contracts, RFPs and Business Support

• Create and maintain standard customer agreements, amendments, renewals, exhibits, clauses and negotiation guidance.
• Enable business leaders to negotiate routine terms within approved templates and guardrails; review, draft and negotiate defined exceptions and material deviations.
• Review vendor agreements, RFPs, proposals and due-diligence responses for material legal or regulatory issues and identify matters requiring specialized review or escalation.
• Advise on contract interpretation, obligations, remedies and material commitments, and standardize responses to recurring legal questions.

Legal Operations and Resource Management

• Assume responsibility for legal intake, review, approval, execution, recordkeeping and matter tracking while maintaining business continuity.
• Improve processes through standards, exception criteria, templates, playbooks, controls and escalation protocols; report on workload, exceptions, significant risks and service levels.
• Manage and prioritize paralegal or contract-administration resources, delegating execution while retaining legal accountability and quality standards.

Regulatory, Licensing and Examinations

• Own the TPA regulatory licensing function, including renewals, registrations, appointments and related filings, with administrative support from the paralegal.
• Interpret regulatory requirements, advise leadership on material developments, and lead or coordinate inquiries, examinations and remediation.
• Coordinate with Claim Operations on compliance, adjuster licensing and related responsibilities to ensure clear accountability and escalation.

Commercial Disputes and Specialty Legal Support

• Own or coordinate routine commercial and contract disputes, interpretation issues and early resolution efforts.
• Engage shared-service or specialty legal resources for litigation, E&O, high-risk disputes, privacy and cybersecurity, employment, governance, novel matters or matters outside delegated authority; serve as TPA coordinating attorney when appropriate.

Decision Authority and Governance

• Determine applicable legal and regulatory requirements, provide independent analysis and recommend appropriate action.
• Business leaders retain decision authority for commercial and operating matters within delegated authority and remain accountable for business commitments.
• Routine agreements within approved templates and guardrails do not require substantive legal approval; defined exceptions and material deviations do.

REQUIRED QUALIFICATIONS

• Juris Doctor (J.D.) degree from an accredited law school.
• Active bar membership in good standing in at least one U.S. jurisdiction and ability to obtain and maintain required in-house registration or limited licensure.
• Minimum 5 years of relevant legal experience; 5-8 years preferred.
• Substantial experience with commercial agreements, practical legal and regulatory advice, and independent legal analysis.
• Experience managing or effectively using paralegal or contract-administration resources.

PREFERRED QUALIFICATIONS AND COMPETENCIES

• Experience in TPA operations, insurance, claims administration or another regulated environment, including licensing or regulatory examinations.
• Experience developing contract templates, playbooks, approval guardrails and exception-based legal review.
• Strong commercial judgment, drafting and negotiation skills, and ability to translate risk into practical business advice.
• Ability to operate independently, manage priorities, determine when legal involvement adds value and work effectively across the business.