Senior Benefits Analyst

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Who we are We are looking for an individual with strong technical expertise for a critical role within the Total Rewards Team.  Reporting to our Senior Manager, Global Benefits, this person will manage the overall administration, oversight, analysis, and claims management of our self-funded medical plan.
The role involves ensuring compliance with regulations, analyzing healthcare cost trends, and working closely with third-party administrators (TPAs) to manage claims, cost containment, and reporting. This analyst is vital in optimizing plan design, reducing costs, and ensuring that the plan meets employee needs while adhering to organizational goals.

Plan Administration:

• Oversee the day-to-day operations of the self-funded medical plan, including claims processing, funding, and reporting
• Work with TPAs to ensure timely and accurate claim adjudication and manage any escalated claim issues
• Work with the finance team to monitor cash flow to ensure that the plan is adequately funded for claim payments and administrative costs
• Oversee Claim Management and Claims Resolution
• Work with Finance to resolve billing question
• Manage High Cost Claim Notifications
• Review Plan Exceptions and flag to the committee for review as appropriate
• Facilitate Monthly Claim Review Meetings with People, Finance, and the Carrier

Cost Analysis & Reporting:

• Analyze healthcare cost trends, claims data, and utilization patterns to identify cost drivers and opportunities for cost savings
• Generate detailed financial reports on the performance of the self-funded plan, including stop-loss analysis, claim frequency, and large claims tracking
• Provide recommendations based on claims data and financial performance analysis

Compliance:

• Ensure the self-funded plan complies with federal and state regulations, such as ERISA, HIPAA, and the ACA
• Assist in preparing required filings, such as Form 5500, ACA, PCORI,  and Summary Plan Descriptions (SPDs)
• Prepare, manage, and send required compliance notices
• Manage Health Care Committee governance, meeting preparation, and charter maintenance
• Stay up-to-date with regulatory changes that affect self-funded plans and ensure compliance, such as Pharmacy Gag Clause and Mental Health Parity Compliance

Vendor & Partner Management:

• Collaborate with the broker to negotiate contracts and terms to optimize plan costs with TPAs, stop-loss carriers, and other vendors
• Serve as the primary point of contact between the organization and external vendors for the self-funded plan
• Conduct performance reviews of vendors and ensure service level agreements (SLAs) and performance guarantees (PGs) are met

Plan Design & Optimization:

• Assess plan design annually (At minimum) and recommend modifications to reduce costs, improve care management, and/or align with employee needs
• Work with actuarial consultants to project costs and set stop-loss limits
• Evaluate wellness programs, disease management initiatives, and other health interventions to enhance plan performance
• Develop utilization dashboards for our entire suite of benefits and benefit line features and report on it monthly

Employee Communication & Education:

• Develop and implement communication strategies to ensure employees understand their medical benefits, claims processes, and any changes to the plan
• Serve as the primary contact for employee inquiries related to the