Claims and Implementation Specialist

Overview

This opportunity is offered through a partner company seeking a Claims and Implementation Specialist located in the United States. The role focuses on facilitating the successful launch and ongoing management of self-funded employee benefit programs by overseeing complex implementation activities alongside claims processes.

Key Responsibilities

• Oversee the post-sale implementation for various benefit programs including stop loss, captive, level-funded, and self-funded plans.
• Create, track, and update implementation schedules, project timelines, and milestones to ensure smooth onboarding.
• Coordinate efforts and communications among employers, consultants, third-party administrators, carriers, vendor partners, and internal teams.
• Lead implementation meetings and deliver timely updates on progress and pending actions.
• Ensure all necessary documentation such as applications, contracts, and enrollment forms are completed and submitted accurately.
• Monitor claims to identify members exceeding thresholds and communicate findings to relevant parties.
• Process eligible claims and advanced funding requests for reimbursements promptly.
• Maintain comprehensive claims records and tracking systems to support quick reimbursements and accurate reporting.
• Verify payment receipts from external partners and record them within internal claim systems.
• Keep company databases and business management systems updated with operational and claims information.
• Propose and implement process improvements to increase efficiency, precision, and the client experience.
• Handle confidential client and claims information with the utmost professionalism and discretion.

Qualifications

• Bachelor’s degree preferred.
• Between 2 to 5 years of relevant experience in employee benefits, healthcare operations, insurance administration, or project coordination.
• Familiarity with client onboarding or benefits implementation projects.
• Knowledge of self-funded health plans, claims administration, reimbursements, or related insurance operations is advantageous.
• Strong project management skills with the capacity to manage several priorities simultaneously.
• Excellent verbal and written communication and presentation capabilities.
• Capability to collaborate effectively with diverse internal and external stakeholders.
• Proactive problem-solving approach and independent work skills complemented by team collaboration.
• High attention to detail and commitment to accuracy in all aspects.
• Ability to securely handle sensitive and confidential information.
• Intermediate to advanced proficiency in Microsoft Excel.
• Possession of a current Life & Health Insurance License or willingness to obtain one within 90 days of hire.

Compensation and Benefits

• Annual salary range of $65,000 to $70,000 depending on experience, skills, and location.
• Potential eligibility for bonuses, commissions, and variable compensation.
• Flexibility to work remotely.
• Comprehensive health, wellness, retirement, and financial benefits.
• Paid time off and other employee support initiatives.
• Reimbursement for job-related expenses as per company policy.
• Employee discount programs and perks.
• Access to learning and development resources for professional advancement.
• Engagement in meaningful work improving healthcare benefit administration.

Additional Information

This role serves as a critical link connecting multiple stakeholders to ensure efficient onboarding and claims management within a collaborative healthcare benefits environment. The position supports improvements in service delivery through meticulous management of timelines, records, and reimbursement processes.

The selection process leverages AI-based tools to objectively assess applications against role requirements before presenting suitable candidates to the hiring company. Final interview and hiring decisions are made internally by the partner organization.

Applicants should note that personal data will be processed according to data protection laws for recruitment purposes, with transparency about the use of AI in the hiring process.