Client Support Specialist

Client Support Specialist

The Client Support Specialist (CSS) serves as the liaison and expert point of contact for employers, brokers and internal ABA team members for their assigned book of business. The Client Support Specialist serves as an important operational resource for the Account Management team and has a key role for account success and retention.

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

• Provides responsive, professional customer service to internal and external stakeholders via email and phone.
• Builds and maintains strong working relationships with clients, brokers, providers, and internal teams.
• Researches and resolves inquiries related to claims, including status requests, EOB requests, plan document interpretation, claims reprocessing, Special Claims Arrangement (SCA) processing, provider outreach, balance billing education, and claims reporting.
• Collaborates with internal departments such as Accounting, Stop Loss, Eligibility, Drug Invoices, Account Management, and others to resolve issues, support client needs, and improve account service and volume.
• Maintains timely communication with stakeholders, including acknowledging inquiries within 24 business hours and providing resolution or status updates within 48 business hours.
• Maintains, documents, and tracks client issues in an accurate, up-to-date resolution log using professional and accurate grammar which can be shared externally. Provides real-time status updates on open items as needed.
• Identifies potential account setup errors and service trends across assigned accounts and the broader book of business, and partners with the Account Executive to address and resolve issues.
• Educates internal and external stakeholders on claims and benefit guidelines, procedures, and best practices, including out-of-contract requests that may impact stop-loss coverage.
• Serves as a subject matter expert during internal and client-facing discussions.
• Monitors claim accuracy and processing trends, providing coaching and guidance to Claim Processors as needed.
• Oversees client-specific claim projects and non-standard workflows to ensure accuracy and success.
• Audits claims for assigned accounts as requested.
• Coordinates member outreach requests with the Customer Service team and follows up to ensure completion.
• Monitors claims backlog for assigned accounts and escalates potential delays to appropriate internal teams.

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

• May perform other duties as required.

Minimum Qualifications (Knowledge, Skills, and Abilities)

• High School Diploma or equivalent required.
• 23 years of experience within the insurance industry, with a focus on client support, account management, or claims administration required.
• Exceptional verbal and written communication skills.
• Service-minded with the ability to be proactive and collaborate effectively.
• Specialized knowledge of stop-loss, self-funded, and/or level-funded account structures preferred.
• Medical claims processing highly preferred.
• WLT Software expertise is highly preferred.

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.