Claim Administrator

Position Title: Benefits & Claims Administrator

Department: Human Resources

Position Summary:

The Benefits & Claims Administrator is responsible for managing and overseeing the company’s self-insured health and welfare benefit plans. This role ensures accurate claims processing, reviews and audits insurance invoices prior to payment, supports cost containment efforts, and serves as the primary liaison between employees and insurance carriers/third party administrators. The position plays a key role in employee education, compliance, and financial stewardship of the company’s benefit program.

• Administer and oversee the company’s self-funded health insurance plan.
• Serve as the primary contact for third-party administrators (TPAs), stop-loss carriers, and insurance vendors.
• Monitor plan performance, utilization trends, and claims activity.
• Ensure plan administration aligns with company policies and regulatory requirements.
• Undertake additional responsibilities as required to support organizational goals.

• Review and audit medical and pharmacy claims for accuracy and eligibility.
• Investigate high-cost or unusual claims and coordinate with carriers or TPAs for clarification.
• Assist employees in reviewing Explanation of Benefits (EOBs) and medical bills.
• Identify billing discrepancies and facilitate corrections with providers or carriers
• Track and document claims activity and cost trends
• Review insurance and TPA invoices for accuracy prior to payment approval.
• Audit monthly claims reports against invoices
• Verify stop-loss reporting and reimbursement documentation
• Identify cost savings opportunities and billing errors
• Maintain documentation supporting all invoice approvals and adjustments.

• Educate employees on plan benefits, coverage options, and cost-saving opportunities
• Assist employees with understanding medical bills, claims denials, and appeals processes.
• Support open enrollment communications and benefit information sessions.
• Provide guidance on wellness initiatives and preventative care utilization
• Serve as liaison between employees and insurance carriers to resolve benefit-related issues.

• Assist in ensuring compliance with applicable federal and state regulations (ERISA, ACA. HIPAA, COBRA, etc.)
• Maintain required plan documentation and Summary Plan Descriptions (SPDs)
• Support audits related to benefit plans and claims administration
• Maintain strict confidentiality of protected health information (PHI)

• Assist in preparing regular claims and utilization reports for leadership
• Assist with tracking cost trends and recommend strategies for cost containment
• Maintain organized records of claims reviews, invoice audits, and vendor communications.

• Associate’s or Bachelor’s degree in Human Resources, Business Administration, Healthcare Administration or related field preferred.
• 2+ years of experience in benefits administration, insurance claims, or healthcare billing preferred.
• Experience with self-funded health plans strongly preferred.
• Working knowledge of ERISA, HIPPA, ACA, and COBRA regulations.
• Strong analytical and financial review skills.
• Ability to interpret Explanation of Benefits (EOBs) and medical billing statements.
• High level of discretion in handling confidential information
• Proficiency in Microsoft Excel and HRIS/benefits platforms.
• Strong communication and problem-solving skills
• Must be physically able to stand, walk, sit, crouch, kneel, climb, and periodically lift 25 pounds
• Able to pass a pre-employment drug screen
• Ability to receive an Arsenal Badge.

Grayson Carter and Son Contracting, Inc. is an Equal Opportunity Employer.

Grayson Carter and Son Contracting, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, veteran status, disability, and/ or other legally protected status.