Client Relationship Manager

ABOUT US

POSITION SUMMARY

DUTIES AND RESPONSIBILITIES

• Serve as the single dedicated point of contact for all employees of the assigned client and for the client's Human Resources department, providing consistent, high-touch service experience.
• Take ownership of member and HR service inquiries from initial contact through resolution, coordinating with appropriate internal departments and external partners rather than transferring ownership whenever possible.
• Field and resolve day-to-day employee questions regarding benefits, claims status, EOBs, eligibility, prior authorizations, billing and other plan-related service needs via phone and email.
• Research and troubleshoot escalated or complex claims and benefit issues, coordinating with Claims, Eligibility, Stop Loss, Accounting, and other internal teams to reach resolution.
• Educate HR contacts regarding existing plan benefits, administrative procedures and established plan provisions, escalating plan design, compliance, contractual or strategic questions to Account Management. Build and maintain strong relationships with the client's HR team and employees and serve as an advocate within ABA, coordinating with Account Management on broker-related matters as appropriate. Coordinate the resolution of escalated member claims and service issues, involving the Account Management, Claims and Operations teams as needed.
• Coordinate with external partners, including network, PBM, UM and other plan vendors to research and resolve member and client service issues.
• Identify recurring claims or service issues based on member and HR inquiries and escalate potential processing trends or systemic issues to Account Management and Operations for review. Acknowledge inquiries within 24 business hours and provide resolution or status updates within 48 business hours.
• Educate employees and HR staff on plan benefits, claims procedures, available resources, and best practices, including guidance that may affect stop-loss coverage.
• Participate in Open Enrollment meetings, benefit fairs, and other client-facing events on behalf of the assigned client. (would like to see if she is doing this now) – I will find out!
• Coordinate and support account-level claims audits as requested.
• Analyze recurring issues or trends specific to the client and proactively identify solutions to improve service and satisfaction.
• Serve as a subject matter expert regarding the assigned client's benefits, member service experience and day-to-day service activity. Other duties as assigned.

• May perform other duties as required.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

• Bachelor's degree in business administration, healthcare management, or a related field preferred. Equivalent work experience may be considered.
• Strong understanding of claims management, benefits administration, and general insurance concepts and terminology required.
• Prior experience in insurance, claims administration, account management, or client/customer service required.
• Excellent oral and written communication skills, including the ability to present to groups such as HR teams and employees during enrollment meetings.
• Strong service orientation, with the ability to remain calm, tactful, and solutions focused when addressing sensitive employee concerns.
• Analytical and problem-solving skills, with the ability to identify trends and recommend process improvements.
• Highly organized and self-directed, with the ability to manage a full caseload independently in a remote work environment.
• PC literate, including proficiency with Microsoft Office products; claims/benefits administration software experience preferred.
• Ability to handle conflict and confront challenging issues professionally in a fast-paced environment.
• Reliable home internet connection and a dedicated, private workspace suitable for handling confidential health information.

OTHER DETAILS

Supervisory Responsibilities

Work Environment

Physical Demands

Travel Requirements

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