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Available Positions

Professional Benefit Administrators leads with one guiding principle, provide exceptional benefit administration for self-funded health plans. Brokers who choose to partner with PBA will benefit from an ally who values cost containment, flexibility, responsiveness, member advocacy, transparency, and results. PBA collectively aligns through the organization’s core values:

  • Work together and respect each other
  • Be dedicated to the customer
  • Be accountable and do what you say
  • Take initiative and be willing to learn
  • Generate positive energy

The positions listed below primarily operate in a professional office environment. However, Professional Benefit Administrators is currently utilizing a hybrid workforce.

To Apply

To apply for a job or submit a resume, please apply online: Apply Now

We are currently hiring for the following positions

The Claims Analyst is responsible for the accurate and timely administration of claims for self-funded employee benefit plans. This position serves as a key liaison between plan participants, employers, providers, insurance carriers, and internal departments to ensure claims are processed in accordance with plan documents, regulatory requirements, and company standards. The ideal candidate possesses strong analytical skills, attention to detail, and experience working within a Third-Party Administrator (TPA) environment.

Responsibilities

  • Review, analyze, and adjudicate medical, dental, vision, and ancillary benefit claims in accordance with plan provisions and company policies.
  • Ensure claims are processed accurately, efficiently, and within established service level standards.
  • Research and resolve complex claim issues, discrepancies, and payment exceptions.
  • Interpret plan documents, Summary Plan Descriptions (SPDs), eligibility records, and benefit provisions.
  • Respond to inquiries from participants, providers, brokers, and employer groups regarding claim status, benefits, and payment determinations.
  • Coordinate with stop-loss carriers and vendor partners as needed.
  • Identify claim trends, errors, and process improvement opportunities.
  • Maintain compliance with ERISA, HIPAA, COBRA, ACA, and other applicable regulations.
  • Document claim activities and maintain accurate records within the claims administration system.
  • Assist with audits, reporting, and quality assurance reviews.
  • Collaborate with customer service, eligibility, enrollment, and account management teams to resolve issues and ensure a positive client experience.
  • Support implementation of new groups, benefit changes, and system updates as required.
  • Perform other duties as assigned.

Minimum Job Requirements

  • High school diploma or equivalent; Associate's or Bachelor's degree preferred.
  • Minimum 2-5 years of claims administration experience, preferably within a TPA, health plan, or insurance environment.
  • Strong understanding of medical claims processing, benefit plan interpretation, and healthcare terminology.
  • Knowledge of self-funded health plans and employee benefits administration.
  • Proficiency in Microsoft Office Suite, particularly Excel.
  • Excellent analytical, organizational, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to manage multiple priorities while maintaining a high level of accuracy.

Preferred

  • Experience working with self-funded employer health plans.
  • Knowledge of stop-loss insurance administration.
  • Familiarity with claims editing software and reporting tools.
  • Experience with or working knowledge of the Javelina claims administration platform strongly preferred.

Benefits and Compensation

  • PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
  • The range for this role is $25-$30 per hour based on prior experience.
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The Member Advocate is responsible for providing excellent customer service to our members and providers. Primary focus will be supporting those in mountain and central time zones. This position requires strong communication skills, problem solving, and overall client satisfaction. This individual reports to the Member Advocacy Manager. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsible For

  • 50+ incoming calls per day to provide quality customer service to callers.
  • Developing and maintaining problem solving skills and troubleshooting abilities for the purpose of assisting callers and going the “extra mile” when necessary.
  • Accurately identifying callers needs, conducting research and assisting with issue resolution.
  • Provide clear communication with focus on empathy and professionalism.
  • Referring to any claims or issues that require adjustments, processing, repricing, or other intervention according to guidelines.
  • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
  • Own issues through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
  • Responding to portals and all e-mails timely.
  • Placing follow-up calls to members and providers, timely.
  • Maintaining a working knowledge of plan benefits.
  • Suggesting process improvement ideas.
  • Presenting problems/trends to Management.
  • Performing other duties as assigned to support PBA’s Mission, Vision and Core Values.

Skills Required for this Position

  • 2+ years in a customer service-oriented role which required communicating over the phone.
  • Maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with customers, clients, co-workers, and management.
  • TPA/Insurance Company environment or medical billing office experience preferred.
  • Customer focused and adaptable to different personality types.
  • Multitask with numerous customer service computer screens.
  • Excellent typing skills, clearly documenting call notes.
  • Active listener and provide empathy and understanding to callers.
  • Strong verbal communication and interpersonal skills.
  • Ability to quickly learn and adapt to new concepts/systems.
  • Professional and responsible work ethic.
  • Ability to interface with various levels of the organization.
  • Proficient in Microsoft Office Suite products.

Essential Functions Statement

  • This role is a remote role requiring the individual to have a private, dedicated space free from distractions.
  • In this position you must be able to exchange accurate information/communication with co-workers, customers and vendors.

Benefits and Compensation

  • PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
  • The range for this role is $23-$25 per hour

Physical Demands

  • This is largely a sedentary role which requires the ability to sit for long periods of time.
  • The person in this position constantly operates a computer.
  • To perform the physical requirements of the position, the employee must be able to have manual dexterity in his or her hands in order to keyboard; see; hear, talk, sit; and stand.
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