People Services, Benefits Specialist II

Clayton

People Services and Benefits Specialist II resolving complex claims and delivering care navigation for Team Members. Leveraging deep benefit knowledge and Workday proficiency in a full-time role.

Posted 5/7/2026full-timeMaryville • Tennessee • 🇺🇸 United StatesMid-LevelSenior💰 $66,495 - $83,115 per yearWebsite

About the role

Key responsibilities & impact

Serve as the escalation for complex medical, pharmacy, dental, vision, COBRA, and similar benefit claims.
Own complex, high-risk benefits cases from intake through full resolution, including proactive follow-up to ensure outcomes such as claims reprocessing, authorizations, and billing corrections.
Proactively review Team Member benefit enrollments and ensure they understand all available benefit options.
Provide concierge advocacy by coordinating directly with carriers—leveraging warm transfers, three-way calls, and direct outreach—to resolve issues.
Deliver personalized, empathetic guidance for sensitive or ongoing medical situations and remain the single point of contact until full resolution.
Monitor high-risk or high-cost cases and proactively engage affected Team Members.

Requirements

What you’ll need

Strong knowledge of medical/pharmacy plan design, claims adjudication, appeals, and coordination of benefits; familiarity with dental/vision/disability/COBRA processes.
Demonstrated proficiency with Workday (or comparable HRIS) for benefits transactions, corrections, reporting, and troubleshooting.
Proven ability to resolve high complexity, high sensitivity cases with confidentiality and professionalism.
Excellent written and verbal communication; strong documentation and stakeholder management skills.
Preferred Experience coordinating with major carriers/TPAs and vendor file interfaces (eligibility, payroll, EDI).
Background in audits/compliance (ERISA/ACA concepts), plan document stewardship, or vendor performance management.
Bachelor’s degree in HR, Business, or related field.
Education: High School Diploma or Equivalent - Bachelor’s degree in HR, Business, or related field preferred.
5+ years in benefits administration, health plan operations, or HR service center roles with advanced claims and member navigation experience.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims adjudicationbenefits coordinationmedical plan designpharmacy plan designdental plan processesvision plan processesCOBRA processesaudits compliancevendor performance managementmember navigation

Soft Skills

empathycommunicationdocumentationstakeholder managementconfidentialityprofessionalismproblem-solvingadvocacyproactive follow-upsensitivity