Senior Benefits Advisor

Benefits Strategy & Plan Design 

• Analyze medical, pharmacy, and ancillary plan designs to identify cost drivers, inefficiencies, and opportunities for improved outcomes. 

• Recommend plan design enhancements that support preventive care, better care navigation, and improved population health while reducing plan costs. 

• Collaborate with brokers, carriers, and consultants on modeling plan design and cost impact scenarios. 

Data & Insight Generation 

• Review claims data, disease burden trends, and utilization patterns to identify proactive cost reduction opportunities. 

• Convert findings into actionable strategies such as steerage programs, enhanced clinical management, or targeted communication initiatives. 

• Prepare dashboards and presentations that simplify complex insights for leadership and stakeholders. 

Employee Experience & Communication 

• Help create clear, empathetic, accessible communications to help employees understand and make the best use of their benefits. 

• Support open enrollment strategy, materials, and presentations. 

• Identify opportunities to help employees choose high value care options and avoid unnecessary costs. 

Vendor & Program Management 

• Evaluate vendor performance, ensuring program design aligns with population health goals and cost management targets. 

• Support implementation of programs such as virtual care, chronic condition management, behavioral health initiatives, or musculoskeletal solutions. 

• Ensure carriers and TPAs meet service guarantees and comply with regulatory and fiduciary requirements. 

• Drive RFP processes to identify innovative, cost-effective‑ vendors, brokers, and TPAs that support improved population health outcomes and reduced plan spend. 

Fiduciary & HIPAA Oversight (Self-Funded Plan) 

• Support the organization’s fiduciary responsibilities under ERISA for our self-funded medical plan, including prudent oversight of plan administration, claims processing, and vendor actions. 

• Assist with preparation and documentation for fiduciary committee meetings, including reporting, decision rationales, and compliance documentation. 

• Monitor plan governance practices to ensure decisions are made solely in the best interest of plan participants. 

• Maintain HIPAA compliance across all benefit functions, including PHI handling, authorization processes, and privacy safeguards. 

• Coordinate required HIPAA training and support audits, breach response procedures, and documentation retention. 

• Partner with internal privacy teams and third-party administrators to ensure adherence to all privacy and security standards. 

Compliance & Administration 

• Ensure benefit programs comply with ERISA, HIPAA, ACA, COBRA, FMLA, and other applicable regulations.