Benefit & Claim Administrator

Grayson Carter and Son Contracting•Athens, AL

About The Position

The Benefits & Claims Administrator is responsible f or managing and overseeing the company’s self-insured health and welfare benefit plans. This role ensures accurate claims processing, reviews and audits insurance invoices prior to payment, supports cost containment efforts, and serves as the primary liaison between employees and insurance carriers/third party administrators. The position plays a key role in employee education, compliance, and financial stewardship of the company’s benefit program.

Requirements

Associate’s or Bachelor’s degree in Human Resources, Business Administration, Healthcare Administration or related field preferred.
2+ years of experience in benefits administration, insurance claims, or healthcare billing preferred.
Experience with self-funded health plans strongly preferred.
Working knowledge of ERISA, HIPPA, ACA, and COBRA regulations.
Strong analytical and financial review skills.
Ability to interpret Explanation of Benefits (EOBs) and medical billing statements.
High level of discretion in handling confidential information
Proficiency in Microsoft Excel and HRIS/benefits platforms.
Strong communication and problem-solving skills
Must be physically able to stand, walk, sit, crouch, kneel, climb, and periodically lift 25 pounds
Able to pass a pre-employment drug screen
Ability to receive an Arsenal Badge.

Responsibilities

Administer and oversee the company’s self-funded health insurance plan.
Serve as the primary contact for third-party administrators (TPAs), stop-loss carriers, and insurance vendors.
Monitor plan performance, utilization trends, and claims activity.
Ensure plan administration aligns with company policies and regulatory requirements.
Undertake additional responsibilities as required to support organizational goals.
Review and audit medical and pharmacy claims for accuracy and eligibility.
Investigate high-cost or unusual claims and coordinate with carriers or TPAs for clarification.
Assist employees in reviewing Explanation of Benefits (EOBs) and medical bills.
Identify billing discrepancies and facilitate corrections with providers or carriers
Track and document claims activity and cost trends
Review insurance and TPA invoices for accuracy prior to payment approval.
Audit monthly claims reports against invoices
Verify stop-loss reporting and reimbursement documentation
Identify cost savings opportunities and billing errors
Maintain documentation supporting all invoice approvals and adjustments.
Educate employees on plan benefits, coverage options, and cost-saving opportunities
Assist employees with understanding medical bills, claims denials, and appeals processes.
Support open enrollment communications and benefit information sessions.
Provide guidance on wellness initiatives and preventative care utilization
Serve as liaison between employees and insurance carriers to resolve benefit-related issues.
Assist in ensuring compliance with applicable federal and state regulations (ERISA, ACA. HIPAA, COBRA, etc.)
Maintain required plan documentation and Summary Plan Descriptions (SPDs)
Support audits related to benefit plans and claims administration
Maintain strict confidentiality of protected health information (PHI)
Assist in preparing regular claims and utilization reports for leadership
Assist with tracking cost trends and recommend strategies for cost containment
Maintain organized records of claims reviews, invoice audits, and vendor communications.