[Hiring] Claims and Implementation Specialist @OneDigital

Role Description

The Claims and Implementation Specialist, Self-Funded Solutions is responsible for coordinating the post-sale implementation and onboarding of new stop loss, captive, and self-funded benefit programs. Serving as a key liaison between clients, consultants, TPAs, stop loss carriers, captive managers, and internal stakeholders, this role ensures a seamless onboarding experience while helping to design, enhance, and improve operational processes that support the Self-Funded Center of Excellence.

• Manage post-sale implementation of new stop loss, captive, level-funded, and self-funded programs.
• Develop, maintain, and oversee implementation timelines and project plans.
• Coordinate onboarding activities between employers, consultants, TPAs, stop loss carriers, captive managers, and vendor partners.
• Facilitate implementation meetings and provide regular status updates to stakeholders.
• Ensure completion and submission of all required implementation documentation, applications, contracts, and enrollment materials.
• Report all members that exceed 50% of the specific deductible to the stop loss vendor.
• Submit eligible paid claims to the excess loss vendor.
• Submit eligible Advanced Funding requests to the excess loss vendor.
• Maintain claims system of record data to track the submissions for turnaround of payment by the excess loss vendor.
• Update and maintain company databases, including D365.
• Verify and post all payments received from the excess loss vendor in the claim system.
• Additional responsibilities as required.

Qualifications

• Strong project management and organizational skills.
• Exceptional attention to detail and ability to manage multiple priorities simultaneously.
• Strong verbal and written communication skills.
• Excellent presentation skills.
• Ability to coordinate across multiple internal and external stakeholders.
• Problem-solving mindset with the ability to identify and resolve issues proactively.
• Strong client service orientation and commitment to delivering a positive client experience.
• Ability to work independently while collaborating within a team environment.
• Ability to handle confidential and sensitive information appropriately.

Requirements

• Bachelor's degree preferred.
• 2–5 years of experience in employee benefits, health insurance, stop loss, TPA operations, captive programs, implementation, account management, or project coordination.
• Intermediate to advanced Microsoft Excel skills.
• Current Life & Health Insurance License or ability to obtain within 90 days of hire.

Benefits

• Base pay range of $65,000 to $70,000 per year.
• Variable compensation, commission, and/or annual bonus based on individual and company performance.
• Health, wellbeing, retirement, and other financial benefits.
• Paid time off and overtime pay for non-exempt employees.
• Robust learning and development programs.
• Reimbursement of job-related expenses per company policy.
• Employee perks and discounts.