Note: The job is a remote job and is open to candidates in USA. Tebra provides an all-in-one EHR platform for independent healthcare practices. The company is seeking a Senior Benefits Administrator to oversee health and welfare plan administration, including self-insured medical plan performance, vendor relationships, financial management, compliance, and employee communications.
Responsibilities
- Claims Analysis & Tracking: Monitor ongoing medical and prescription drug claims performance; identify trends, high-cost claimants, and cost-driver patterns in partnership with plan actuaries and brokers
- Stop-Loss Administration: Coordinate stop-loss policy renewals, track claims reaching individual/aggregate stop-loss thresholds, and submit reimbursement filings to carriers
- TPA & Vendor Governance: Oversee relationships with Third-Party Administrators (TPAs), Pharmacy Benefit Managers (PBMs), and Benefits broker and carriers. Ensure operational execution according to SLAs
- Funding & Reconciliations: Partner with Payroll and Accounting to manage weekly/monthly billing, claims funding requests, reserve requirements (IBNR tracking), and employee contribution and invoice reconciliations
- Open Enrollment: Lead the annual Open Enrollment process, including system updates, open enrollment communications, employee informational sessions, and post-enrollment audits
- Life Events & Ongoing Administration: Manage day-to-day enrollment changes, qualifying life events (QLEs), dependent eligibility verifications, and COBRA processing
- Disability & Leave Coordination: Support short-term/long-term disability programs and align benefit premiums during active FMLA/LOA periods
- Regulatory Reporting: Ensure strict compliance with federal and state regulations, including ERISA, ACA (1094/1095 reporting), HIPAA, COBRA, and FMLA
- Plan Documentation: Maintain updated Summary Plan Descriptions (SPDs), Summaries of Benefits and Coverage (SBCs), Plan Documents, and Form 5500 filings
- Nondiscrimination Testing: Coordinate annual 105(h) and Section 125 nondiscrimination testing with third-party compliance specialists
- Annual Benefits Audits: Lead annual 401K audit and execute dependent eligibility and enrollment audits throughout the year
- Escalated Claims Support: Act as the primary point of contact for complex, escalated employee claims issues, serving as an advocate while maintaining plan governance
- Benefits Communication: Draft clear, accessible employee communications explaining self-insured plan features, cost-saving tools (e.g., telehealth, centers of excellence), and wellness incentive initiatives
Skills
- Bachelor's Degree in Human Resources, Business Administration, Finance, or a related field (or equivalent practical experience)
- 5 years of direct experience dedicated to health & welfare plan administration
- Demonstrated experience managing self-insured / self-funded medical plans, including working with stop-loss insurance, TPAs, and PBMs
- Experience administering benefits using Workday
- Advanced skills in MS Excel (Pivot Tables, VLOOKUP/XLOOKUP, data modeling) to analyze large sets of claims and census data
- Deep functional knowledge of ERISA, ACA, HIPAA, COBRA, and IRS Section 125 rules
- CEBS (Certified Employee Benefit Specialist), SHRM-CP/SHRM-SCP, or PHR/SPHR
Benefits
- Eligible employees have the opportunity for variable pay
- A robust benefits package
- United States: healthcare benefits
- United States: a discount through Dell for work-from-home basics
- United States: resources to help you keep your mind and body healthy
- United States: Gympass for a great workout
- United States: Telus Employee Assistance Program for mental health resources
- United States: other resources for everyday occurrences
Company Overview