Claims and Implementation Specialist - jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims and Implementation Specialist based in United States.

This role supports the successful launch and ongoing administration of self-funded benefit programs by coordinating complex implementation activities and claims processes. You will serve as a key connection point between clients, consultants, vendors, and internal teams to ensure smooth onboarding experiences. The position combines project coordination, operational support, claims monitoring, and process improvement within a collaborative healthcare benefits environment. You will help strengthen service delivery by managing timelines, maintaining accurate records, and supporting efficient reimbursement workflows. The ideal candidate is organized, detail-oriented, and comfortable managing multiple priorities while building strong stakeholder relationships. This remote opportunity offers the chance to contribute to solutions that improve healthcare benefit administration for organizations and their employees.

Accountabilities:

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: