People Services, Benefits Specialist II

Role Overview

• 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

• 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.

Benefits

• Full-time team members have the flexibility to create their own health, dental, and vision benefits package.
• Clayton provides competitive 401K programs, including investment options and company matching for full and part-time team members after one year.
• Additional benefits include paid parental leave, tuition reimbursement, Employee Assistance Programs, and more.
• Clayton is now providing paid time for Team Members to volunteer to causes that are meaningful to them through the Clayton Impact program.
• Clayton encourages holistic wellness with physical, nutritional, social, financial, spiritual, and occupational programs available online or in-person for team members.
• Clayton’s Home Office campus offers an onsite restaurant, onsite fitness facility with full gym, in-person and virtual workout classes, yoga/barre studio, volleyball and basketball courts, walking paths, and a disc golf course.