Operations Specialist

Health insurance client service CRM systems health plan administration self-funding stop loss provider networks Direct Primary Care (DPC) enrollment benefits administration onboarding proposal preparation RFP responses organizational skills communication

About the role

Operations Specialist at Self Fund Health

Responsibilities: Serve as the first point of contact for routine client inquiries, escalating as needed. Provide timely and accurate responses regarding benefits, enrollment, billing, provider networks, and policy details. Conduct virtual or in-person training for employers and brokers on portals, billing, and enrollment processes. Document interactions in CRM and identify opportunities for process improvements.

Support onboarding of new clients, including setup of portals, contracts, enrollment, and member materials (SBCs, SPDs, Guides). Coordinate across sales, plan management, and vendor partners to ensure a seamless launch. Help manage open enrollment processes, including communications, scheduling, and member education sessions.

Track and manage client requests to resolution. Support proposal preparation, RFP responses, and reporting for the sales team. Assist with plan renewals by gathering documents, preparing reports, and coordinating timelines. Identify operational gaps and recommend process enhancements to improve efficiency.

Requirements: Location: Wisconsin-based remote, with knowledge of the regional healthcare and broker landscape. 3-5 years in health insurance or a related field, ideally with exposure to self-funding, stop loss, or provider networks. Solid understanding of health insurance fundamentals; exposure to DPC and free-market healthcare models a plus. Strong client service orientation, excellent communication, and proficiency with CRM systems. Mission-driven, adaptable, and eager to improve healthcare outcomes while reduce costs for local businesses. Remote role with occasional travel within Wisconsin and surrounding states.