Implementation Specialist

Job Description

JOB DETAILS

REQUIREMENTS

• 2+ years of experience in benefits administration, health insurance implementation, or case building.
• Strong understanding of group health insurance products, including MEC, MVP, level-funded, and self-funded plans.
• Experience working with benefits administration platforms (e.g., EDI systems, TPA software, or enrollment platforms).
• Proficiency in handling enrollment data, eligibility files, and carrier integrations.
• Excellent attention to detail, problem-solving skills, and ability to manage multiple tasks in a fast-paced environment.
• Strong communication and collaboration skills to work effectively with internal teams and external partners.
• Experience with API integrations and data mapping (preferred).
• Familiarity with compliance regulations (ACA, HIPAA, etc.) is a plus.

RESPONSIBILITIES

• Case Setup & Configuration:
  • Configure employer group benefits, including MEC, MVP, level-funded, and self-funded plans.
  • Input plan details, rates, eligibility rules, and carrier requirements into the system.
  • Ensure all case builds meet compliance, regulatory, and business requirements.
• Implementation & Onboarding:
  • Support the implementation process for new clients and renewals from beginning to end.
  • Work with brokers, TPAs, underwriters, and internal teams to validate plan setup.
  • Conduct data audits to ensure system accuracy and troubleshoot discrepancies.
• Data Management & System Integration:
  • Load and validate enrollment data and eligibility files.
  • Collaborate with IT and development teams for API integrations with carriers and vendors.
  • Maintain documentation for system configurations and implementation processes.
• Client Support & Troubleshooting:
  • Serve as a key point of contact for implementation-related inquiries.
  • Provide ongoing support for case modifications, corrections, and updates.
  • Identify process improvements to enhance implementation efficiency.

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