Role overview
Benefits Specialist manages health and welfare benefits, with particular responsibility for a self-insured medical plan, claims analysis, and vendor performance. Reporting to the HR Operations Director, the role connects day-to-day administration with plan strategy across medical, dental, vision, life, disability, 401K, and wellness offerings.
Plan Performance and Administration
- Analyze medical and prescription claims with actuaries and brokers to identify trends, high-cost claimants, and major cost drivers.
- Coordinate stop-loss renewals, monitor individual and aggregate thresholds, and submit carrier reimbursement filings.
- Manage Third-Party Administrators, Pharmacy Benefit Managers, benefits brokers, and carriers against service-level commitments.
- Work with Payroll and Accounting on weekly and monthly billing, claims funding, reserve requirements including IBNR tracking, employee contributions, and invoice reconciliations.
- Lead annual open enrollment, including system changes, communications, employee information sessions, and enrollment audits.
- Administer enrollment changes, qualifying life events, dependent eligibility verification, and COBRA processing.
- Support short- and long-term disability programs and coordinate benefit premiums during FMLA and other leaves of absence.
- Maintain compliance with federal and state requirements, including ERISA, ACA 1094/1095 reporting, HIPAA, COBRA, and FMLA.
- Keep Summary Plan Descriptions, Summaries of Benefits and Coverage, plan documents, and Form 5500 filings current.
- Coordinate annual Section 105(h) and Section 125 nondiscrimination testing with compliance specialists; lead the annual 401K audit and conduct dependent eligibility and enrollment audits.
- Resolve escalated employee claims issues while maintaining plan governance, and explain self-insured benefits, telehealth, centers of excellence, and wellness incentives in accessible communications.
Benefits Expertise
- A bachelor’s degree in Human Resources, Business Administration, Finance, or a related field, or equivalent practical experience.
- Five years of experience dedicated to health and welfare plan administration.
- Experience managing self-insured or self-funded medical plans and working with stop-loss insurance, TPAs, and PBMs.
- Experience administering benefits in Workday.
- Advanced Excel skills, including Pivot Tables, VLOOKUP/XLOOKUP, and data modeling for large claims and census datasets.
- Deep working knowledge of ERISA, ACA, HIPAA, COBRA, and IRS Section 125 rules, together with strong analytical and employee communication skills.
Preferred credentials
- CEBS, SHRM-CP/SHRM-SCP, or PHR/SPHR certification.
Location and Pay
This is a remote position in the United States. Base compensation for Zone 1, the National Average, is USD $90,000–$103,000. Individual compensation depends on experience, qualifications, role requirements, and geographic zone. Zone 2 covers moderately higher-cost regions, Zone 3 high-cost regions, and Zone 4 lower-cost regions. The range for the applicable zone will be discussed during the initial talent screen. Eligible employees may also receive variable pay and benefits.
Benefits and Hiring Information
U.S. benefits include healthcare coverage, a Dell discount for work-from-home equipment, Gympass fitness resources, and the Telus Employee Assistance Program for mental health and everyday support.
Phone and video screenings may be recorded and transcribed using Greenhouse Notetaker to support consistent hiring decisions. Applying acknowledges that interviews may be recorded. Recruiting communication uses official company email or Greenhouse; sensitive information is requested through the official application portal, and interviews are not conducted through instant messaging. California applicants are covered by the employer’s California privacy notice. Equal employment opportunity applies to all qualified candidates.