Claims and Implementation Specialist - Remote

About the role

The OneDigital Self-Funded Center of Excellence (SFCOE) provides comprehensive self-funding solutions and support, including traditional stop loss, captives, level-funded options, and TPA (ASO) marketing. Our goal is to match each client with the right self-funded strategy based on their risk-profile while reducing complexity for the field and ensuring clients receive competitive pricing and best-in-class contract terms.

Responsibilities

• Manage post-sale implementation of new stop loss, captive, level-funded, and self-funded programs.
• Develop, maintain, and oversee implementation timelines and project plans.
• Cook up 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 turn-around 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.

Qualifications, Skills and Requirements

• 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.

Education, Training and Experience

• Required: 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

We offer a comprehensive benefits package including health, wellbeing, retirement, and other financial benefits, paid time off, overtime pay for non-exempt employees, and robust learning and development programs. You will also receive reimbursement of job-related expenses per the company policy and may receive employee perks and discounts. We are committed to fostering a diverse and inclusive workplace and providing equal employment opportunities to all qualified individuals.

Pay

The typical base pay range for this role nationwide is $65,000 to $70,000 per year. Your base pay is dependent upon your skills, education, qualifications, professional experience, and location. In addition to base pay, some roles are eligible for variable compensation, commission, and/or annual bonus based on your individual performance and/or the company’s performance.

Schedule

Details on the schedule will be provided during the interview process.