Claims Funding Specialist

Health Plans Inc

6h•Hybrid

About The Position

At HPI, we are a forward-thinking, national third-party administrator (TPA) specializing in self-funded health plan solutions. With over 44 years of industry expertise, our entrepreneurial spirit, flexible approach, and personalized service have empowered us to serve clients of all sizes across diverse industries. We deliver innovative strategies that maximize the value of every healthcare dollar. The self-funded health plan landscape is constantly evolving. At HPI, our partners benefit from having a TPA with the expertise, resources, and creativity to deliver customized plan solutions that help them win and retain more business. We excel at driving costs down and managing risk, while enhancing our clients’ employees’ health insurance experience. Our goal is to help members clearly understand their health plan and provide responsive service, enabling them to fully utilize their benefits and achieve greater health. Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service. The Funding Specialist is responsible for coordinating daily account activity for employer groups who self-fund their health, dental and short-term disability benefit programs. As such, the specialist manages information for clients in the areas of funding, billing and reporting of financial transactions.

Requirements

High School Diploma or equivalent
1+ year of accounts payable, cash management, or reconciliation functions
Experience reconciling monthly and year-end financial reporting
Demonstrated ability to manage time-sensitive, high-accuracy work in a deadline-driven environment
Proven ability to identify financial discrepancies or risk and escalate appropriately
Working knowledge of Microsoft Excel (e.g., formulas, basic reconciliations, data tracking) and Outlook
Experience handling confidential financial or health-related information in compliance with privacy standards
Strong written and verbal communication skills, with experience communicating directly with clients or external partners
Effective problem-solving and influencing skills
Strong organizational, self-motivation, and decision-making skills
Ability to work independently and collaboratively, as needed
Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Nice To Haves

Some secondary education
Exposure to finance and/or accounting principles
1–3 years of experience in one or more of the following areas: Health plan administration (TPA environment strongly preferred), Claims funding, billing, or financial operations
Direct experience with: Claims funding cycles, Employer-funded benefit plans, and Stop-loss coordination or reimbursement processes
Advanced Excel skills (e.g., pivot tables, lookups, multi-sheet workbooks)
Experience supporting multiple employer groups simultaneously

Responsibilities

Communicate with clients regarding funding requirements based on approved expenses of the plan
Coordinate and schedule payments to providers and other payees on behalf of client
Communicate with account managers and various other departments according to client needs
Maintain and reconcile client cash account used to pay plan expenses
Reconcile monthly and year end reporting to reflect reimbursements, refunds, voids, etc.
Maintain documents such as verification of client check run, funding date and release of payments and EOB/EOP(s)
Keep accurate records of client funding expectations and reporting needs
Work with Finance staff to ensure client account maintains a positive balance
Work with Stop Loss team to ensure provider payments are funded and paid according to stop loss contract guidelines
Research client issues relating to inquiries and/or delinquency of claims funding
Develop and maintain excellent working relationships with all internal and external contacts
Understand and appreciate the need for a sense of urgency and accuracy with all work activities and communicate appropriately with department leadership to coordinate response/resolution.
Meet and/or exceed all defined performance expectations at an individual and department level
Evaluate opportunities for process improvement and implement solutions producing desired outcomes
Perform other various duties deemed necessary to provide client administrative services