Claims and Implementation Specialist - Remote at Digital Insurance LLC

Employee Benefits is the core of our business and at our heart we are a people-focused organization. Every day, we help over 100,000 employers give their employees peace of mind by providing health, pharmacy, long and short-term disability, vision, dental and other insurance solutions. What makes us unique is that we can surround our clients with more services and more technology-based tools and a team of advisors that simply cares more than anyone else.

If you want a career giving people the reassurance that they can have access to the health care they need for themselves and their loved ones, join OneDigital.

Our Newest Opportunity:

The OneDigital Self-Funded Center of Excellence (SFCOE) provides OneDigital offices with a full suite of 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.

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. The specialist will coordinate across multiple internal teams and external partners to streamline workflows, improve service delivery, drive operational consistency, and support the successful administration of self-funded programs through ongoing claims monitoring, reimbursement tracking, and carrier reporting activities.

Essential Duties and Responsibilities (include but are not limited to):

• 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 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.
• Additional responsibilities as required

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.

Preferred

• Experience with self-funded health plans, stop loss insurance, captive programs, or third-party administration.
• Experience managing client implementations or onboarding projects.
• Familiarity with carrier, captive, and TPA implementation requirements.
• Knowledge of stop loss reimbursement processes and claims administration.

The typical base pay range for this role nationwide is $65,000 to $70,000 per year.

City and County of San Francsico

City of Los Angeles

County of Los Angeles

If you have questions about our hiring policies and practices, we would be happy to discuss upon receiving your application. We hope to welcome you to OneDigital and look forward to hearing from you.

OneDigital understands the immense responsibility and opportunities provided by Artificial Intelligence. We utilize advanced Artificial Intelligence [AI] technologies to enhance our recruitment process. This includes using AI to filter candidates based on their qualifications and to rediscover potential candidates from our existing applicant pool. Our AI systems help us efficiently identify the best fit for our open positions, ensuring a streamlined and effective hiring experience. However, AI does not replace the humans in our process. If you have concerns about our use of AI, you may opt out where laws allow.

Thank you for your interest in joining the OneDigital team!