Client Relationship Manager

ABOUT US

Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.

 
ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States.

POSITION SUMMARY

The Client Relationship Manager serves as the primary point of contact for an assigned client's employees and Human Resources team, delivering a consistent, high-touch service experience throughout the healthcare journey. This role owns member and HR inquiries from first contact through resolution, partnering with Claims, Eligibility, Stop Loss, Accounting, Account Management, and external plan vendors to resolve issues efficiently and accurately. The Client Relationship Manager also educates HR contacts and employees on plan benefits and procedures and other client events and identifies recurring service trends to help drive continuous improvement. Success in this role requires strong service orientation, sound working knowledge of claims and benefits administration, and the ability to manage a full client caseload independently in a remote environment.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• 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.

Other job duties include, but are not limited to the following:

• 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

None

Work Environment

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.