Senior Benefits Administrator

About the Role

We are seeking an experienced and analytical Senior Benefits Administrator to oversee the day-to-day administration and strategic alignment of our health and welfare plans. Reporting directly to the HR Operations Director, this role plays a pivotal part in managing our self-insured medical plan, monitoring plan performance, managing Third-Party Administrator (TPA) relationships, and ensuring compliance across all health and welfare offerings (medical, dental, vision, life, disability, 401K and wellness).

The ideal candidate possesses deep expertise in ERISA, HIPAA, and ACA compliance, strong data analytics capabilities to evaluate claim trends, and exceptional employee communication skills to deliver a seamless experience.

Your Area of Focus

Self-Insured Plan Oversight & Financial Management

• Claims Analysis & Tracking: Monitor ongoing medical and prescription drug claims performance; identify trends, high-cost claimants, and cost-driver patterns in partnership with plan actuaries and brokers.
• Stop-Loss Administration: Coordinate stop-loss policy renewals, track claims reaching individual/aggregate stop-loss thresholds, and submit reimbursement filings to carriers.
• TPA & Vendor Governance: Oversee relationships with Third-Party Administrators (TPAs), Pharmacy Benefit Managers (PBMs), and Benefits broker and carriers. Ensure operational execution according to SLAs.
• Funding & Reconciliations: Partner with Payroll and Accounting to manage weekly/monthly billing, claims funding requests, reserve requirements (IBNR tracking), and employee contribution and invoice reconciliations.

Health & Welfare Plan Administration

• Open Enrollment: Lead the annual Open Enrollment process, including system updates, open enrollment communications, employee informational sessions, and post-enrollment audits.
• Life Events & Ongoing Administration: Manage day-to-day enrollment changes, qualifying life events (QLEs), dependent eligibility verifications, and COBRA processing.
• Disability & Leave Coordination: Support short-term/long-term disability programs and align benefit premiums during active FMLA/LOA periods.

Compliance & Governance

• Regulatory Reporting: Ensure strict compliance with federal and state regulations, including ERISA, ACA (1094/1095 reporting), HIPAA, COBRA, and FMLA.
• Plan Documentation: Maintain updated Summary Plan Descriptions (SPDs), Summaries of Benefits and Coverage (SBCs), Plan Documents, and Form 5500 filings.
• Nondiscrimination Testing: Coordinate annual 105(h) and Section 125 nondiscrimination testing with third-party compliance specialists.
• Annual Benefits Audits: Lead annual 401K audit and execute dependent eligibility and enrollment audits throughout the year.

Employee Experience & Communications

• Escalated Claims Support: Act as the primary point of contact for complex, escalated employee claims issues, serving as an advocate while maintaining plan governance.
• Benefits Communication: Draft clear, accessible employee communications explaining self-insured plan features, cost-saving tools (e.g., telehealth, centers of excellence), and wellness incentive initiatives.

Your Professional Qualifications

Education & Experience

• Bachelor’s Degree in Human Resources, Business Administration, Finance, or a related field (or equivalent practical experience).
• 5 years of direct experience dedicated to health & welfare plan administration.
• Demonstrated experience managing self-insured / self-funded medical plans, including working with stop-loss insurance, TPAs, and PBMs.
• Professional Certifications (Preferred): CEBS (Certified Employee Benefit Specialist), SHRM-CP/SHRM-SCP, or PHR/SPHR.

Technical & Analytical Skills

• HRIS Proficiency: Experience administering benefits using Workday.
• Data & Excel Mastery: Advanced skills in MS Excel (Pivot Tables, VLOOKUP/XLOOKUP, data modeling) to analyze large sets of claims and census data.
• Regulatory Depth: Deep functional knowledge of ERISA, ACA, HIPAA, COBRA, and IRS Section 125 rules.