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Health Plans, Inc

<div><div><b>Position: Claims Funding Specialist</b></div><div><b>
Department: Fund Accounting</b></div><div><b>
Reports To: Director of Fund Accounting</b></div><div><b>
FLSA Status: Non-exempt</b></div><div></div><div><b><br>
About HPI</b></div><div>
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.</div><div></div><div><br>
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&rsquo; employees&rsquo; 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.</div><div></div><div><br>
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&rsquo;s growth and well-being, we ensure they are equipped to provide exceptional service.</div><div></div><div><b><br>
Summary:</b></div><div>
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.</div><div></div><div><b><br>
Duties and Responsibilities (other duties may be assigned):</b></div><ul><li>
Communicate with clients regarding funding requirements based on approved expenses of the plan</li><li>
Coordinate and schedule payments to providers and other payees on behalf of client</li><li>
Communicate with account managers and various other departments according to client needs</li><li>
Maintain and reconcile client cash account used to pay plan expenses</li></ul><div><ul><li>
Reconcile monthly and year end reporting to reflect reimbursements, refunds, voids, etc.</li><li>
Maintain documents such as verification of client check run, funding date and release of payments and EOB/EOP(s)</li><li>
Keep accurate records of client funding expectations and reporting needs</li></ul></div><ul><li>
Work with Finance staff to ensure client account maintains a positive balance</li><li>
Work with Stop Loss team to ensure provider payments are funded and paid according to stop loss contract guidelines</li></ul><div><ul><li>
Research client issues relating to inquiries and/or delinquency of claims funding</li><li>
Develop and maintain excellent working relationships with all internal and external contacts</li><li>
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.</li><li>
Meet and/or exceed all defined performance expectations at an individual and department level</li><li>
Evaluate opportunities for process improvement and implement solutions producing desired outcomes</li></ul></div><ul><li>
Perform other various duties deemed necessary to provide client administrative services</li></ul><p></p><p><b><br>
Minimum Education Requirements (must have documented proof*):</b></p><div><ul><li>
High School Diploma or equivalent</li></ul></div><p></p><p><b><br>
Minimum Experience Requirements:</b></p><div><ul><li>
1+ year of accounts payable, cash management, or reconciliation functions</li><li>
Experience reconciling monthly and year-end financial reporting</li><li>
Demonstrated ability to manage time-sensitive, high-accuracy work in a deadline-driven environment</li><li>
Proven ability to identify financial discrepancies or risk and escalate appropriately</li><li>
Working knowledge of Microsoft Excel (e.g., formulas, basic reconciliations, data tracking) and Outlook</li><li>
Experience handling confidential financial or health-related information in compliance with privacy standards</li><li>
Strong written and verbal communication skills, with experience communicating directly with clients or external partners</li><li>
Effective problem-solving and influencing skills</li><li>
Strong organizational, self-motivation, and decision-making skills</li><li>
Ability to work independently and collaboratively, as needed</li></ul></div><p></p><p><b><br>
Preferred Education Requirements:</b></p><div><ul><li>
Some secondary education</li><li>
Exposure to finance and/or accounting principles</li></ul></div><div></div><div><b><br>
Preferred Experience Requirements:</b></div><div><ul><li>
1&ndash;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</li><li>
Direct experience with: Claims funding cycles, Employer-funded benefit plans, and Stop-loss coordination or reimbursement processes</li><li>
Advanced Excel skills (e.g., pivot tables, lookups, multi-sheet workbooks)</li><li>
Experience supporting multiple employer groups simultaneously</li></ul></div><div></div><div><b><br>
Computer Skills:</b></div><div><ul><li>
Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint</li></ul></div><p></p><div><b><br>
Reasonable Accommodation:</b></div><div>
Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.</div><div></div><div><b><br>
Working Location/Working Environment/Physical Demands:</b></div><p>
This role is hybrid with the expectation the candidate come onsite in the Westborough MA office 2-3 days per week.</p><div>
The work environment characteristics and physical demands described here are representative of those an employee may encounter while performing the duties of this job.</div><div></div><div><br>
The noise level in the work environment is moderate. The employee may occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, walk, speak, or hear. The employee is frequently required to use hands or feel or handle items as well as reach with hands and arms. The employee is occasionally required to stand.</div><div></div><div><b><br>
Disclaimer</b></div><div>
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.</div><div></div><div><br>
***Deadline to apply is 4/7/2026****</div><div></div><p><b><i><br>
Health Plans Inc. is an EEO &ndash; M/F/D/V employer</i></b></p></div>

Claims Funding Specialist

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Health Plans, Inc

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Claims Funding Specialist