Claims and Implementation Specialist

The Claims and Implementation Specialist will coordinate post-sale implementation activities and support the operational management of self-funded benefit programs. This role requires strong organization, communication, and attention to detail to ensure successful client onboarding, accurate claims administration, and consistent service delivery.

• Manage implementation activities for new stop loss, captive, level-funded, and self-funded benefit programs.
• Develop, maintain, and monitor implementation schedules, project plans, and key milestones.
• Coordinate onboarding efforts between employers, consultants, third-party administrators, carriers, vendor partners, and internal stakeholders.
• Facilitate implementation meetings and provide timely updates on project progress and outstanding actions.
• Ensure completion and submission of required documentation, applications, contracts, and enrollment materials.
• Monitor claims activity and report members exceeding applicable thresholds to relevant partners.
• Submit eligible claims and advanced funding requests for reimbursement processing.
• Maintain accurate claims records and tracking systems to support timely reimbursement and reporting.
• Verify and record payments received from external partners within internal claims systems.
• Maintain company databases and operational records, including updates within business management platforms.
• Identify process improvements that enhance efficiency, accuracy, and client experience.
• Handle confidential client and claims information with professionalism and discretion.

Requirements:

The ideal candidate will have experience in employee benefits, healthcare operations, insurance administration, or project coordination, with the ability to manage complex workflows and collaborate with multiple stakeholders. Strong organizational skills, communication abilities, and attention to detail are essential for success in this role.

• Bachelor’s degree preferred.
• 2–5 years of experience in employee benefits, health insurance, stop loss, third-party administration, captive programs, implementation, account management, or project coordination.
• Experience supporting client onboarding projects or operational implementations.
• Knowledge of self-funded health plans, claims administration, reimbursement processes, or related insurance operations preferred.
• Strong project management and organizational skills with the ability to manage multiple priorities.
• Excellent verbal and written communication skills.
• Strong presentation and stakeholder management abilities.
• Ability to collaborate effectively with internal teams and external partners.
• Strong problem-solving skills with a proactive approach to resolving issues.
• Ability to work independently while contributing effectively within a team environment.
• Advanced attention to detail and commitment to accuracy.
• Ability to manage confidential and sensitive information appropriately.
• Intermediate to advanced Microsoft Excel skills.
• Current Life & Health Insurance License or ability to obtain within 90 days of hire.

Benefits:

• Competitive annual salary range of $65,000–$70,000, depending on experience, qualifications, and location.
• Potential eligibility for variable compensation, commission, and/or annual bonus programs.
• Remote work flexibility.
• Health, wellbeing, retirement, and financial benefit programs.
• Paid time off and additional employee support programs.
• Job-related expense reimbursement according to company policies.
• Employee perks and discount opportunities.
• Learning and development programs to support professional growth.
• Opportunity to contribute to meaningful healthcare benefit solutions.