Finance Operations Specialist

Health Plans Inc

11h•Onsite

About The Position

The Finance Operations Specialist is an experienced professional with proven skills in third party claims administration and a working knowledge of related processes. The primary responsibility of this position is the complete administrative oversight of the client’s claims billing, funding, and stop loss filing & reimbursement processes. 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.

Requirements

Associates Degree or 2 years of relevant work experience
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
Risk awareness and escalation judgment
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

Nice To Haves

Working knowledge of banking processes, ACH funding, reconciliation, and payment file management.
Proficiency with claims administration systems (Javelina) and financial tracking tools
Experience with cross‑functional process management and issue resolution.
Demonstrated commitment to maintaining confidentiality and ethical practice.
Experience supporting self‑funded health plans and employer‑funded claim payment models.
Client‑focused problem solving

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
Notify client of check run amounts, provide check registers and review client authorizations
Generate, deliver, and reconcile files to external payment vendors to ensure the issuance of checks, EFT, and EOB(s)
Maintain documents such as verification of client check run, funding date and release of payments and EOB’s/ERA.
Keep accurate records of client funding expectations and reporting needs.
Ensure payment timeliness and accuracy by maintaining strong internal controls and quality checkpoints.
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 outside of the normal process.
Research payment status and process voids as needed.
Submit first notification of loss, specific reimbursement requests, and follow ups as needed to stop loss carrier partners
Record and distribute explanation of reimbursements and specific stop loss checkruns for clients
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
Other duties as assigned.