Automation & Compliance Operations Specialist

First Choice Health; Seattle (WA); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Health Insurance

401(k) match

Paid Time Off

Tuition Reimbursement

EAP

Wellness program

Job summary

First Choice Health, headquartered in Seattle, WA, seeks an Operations Specialist to manage enrollment quality control, COBRA administration, and complex claims disputes for self-funded employer clients.

You will automate data workflows using AI tools, ensure 100% compliance in enrollment and COBRA processes, and draft high-quality appeal determinations in collaboration with stop-loss carriers and plan documents.

Qualifications

• 2+ years of experience in TPA operations, benefits administration, or medical claims.
• Solid understanding of ERISA, COBRA, HIPAA, and PPACA regulations, particularly for self-funded group health plans.
• Experience with TPA administration platforms (LuminX, Eldorado/Javelina, WLT) and advanced Microsoft Excel skills (VLOOKUP/XLOOKUP, Pivot Tables, Power Query).
• Practical experience utilizing AI tools (like ChatGPT, Claude, Gemini, or Copilot) to draft correspondence, summarize complex information, or analyze tabular data.

Responsibilities

• Automate enrollment & eligibility quality control tasks and validate weekly EDI 834 files.
• Oversee COBRA administration, communications, and compliance within ERISA timelines.
• Conduct end-to-end appeals adjudication and draft clear, legally defensible determinations.
• Identify and build automated solutions using AI/RPA to reduce manual work and errors.

Skills

TPA operations

Benefits administration

Medical claims

ERISA knowledge

AI tools usage

Advanced Excel

Tools

LuminX

Eldorado/Javelina

WLT

Job description

First Choice Health, headquartered in Seattle, WA, seeks an Operations Specialist to manage enrollment quality control, COBRA administration, and complex claims disputes for self-funded employer clients.

You will automate data workflows using AI tools, ensure 100% compliance in enrollment and COBRA processes, and draft high-quality appeal determinations in collaboration with stop-loss carriers and plan documents.