Full time

Client Service/ Claims Manager

Atlanta, GeorgiaJob reference #: MR10/19/17


Position Overview

This manager will be responsible for the delivery of superior client service through leadership and development of client relations and member relations team to client's client base. Included is the oversight of the day-to-day operational needs of the clients and members, providing support to both teams and reviewing & resolving escalated issues from both clients and members alike. Position will enforce current standards as well policies & procedures while also making recommendations on process improvements.


Summary of Responsibilities

· Maintains HIPAA guidelines within business units.

· Establishes and recommends departmental goals and action plans that support and build client loyalty.

· Recommends new positions and new hires.

· Monitors departmental effectiveness and prepares progress and productivity reports for presentation to company alignment metric (CAM) team and/or executive management.

· Meets and exceeds client service level agreement (SLA) requirements.

· Develops and maintains client service reporting tools required to manage SLAs.

· Collaborates with all other departments to ensure that client standards for service are being met and/or exceeded.

· Develops direct reports through on-going feedback, coaching and mentoring as well as bi-annual associate evaluations.

· Ensures appropriate standards are maintained for all client-facing internet applications

· Communicates with employees through periodic department meetings.

· Reports client trends, positive and negative, to account management and/or senior management.

· Provide operational support to the regional account management team on client escalated issues.

· Participates in client education programs with Regional Account Managers.

· Makes recommendations for employee training needs.

· Maintains, enforces and recommends additional departmental policies and procedures.

· Develops and administers client surveys.

· Assists with the development and management of the department budget.

· Promotes company core values and foundational attributes.

· Completes miscellaneous tasks as assigned by leadership.


Summary of Qualifications

· Superior client service skills.

· Work effectively with varying internal partners.

· Make staffing recommendations.

· Enforce current and implement new processes.

· Demonstrate excellent written and verbal communication skills.

· Recognize system limitations and make recommendations for change.

· Act as business sponsor on technical and non-technical projects.

· Support challenging clients and/or providers with diplomacy.

· Maintain audit/quality metrics for all functional areas.

· Troubleshoot system applications for clients when necessary.

· Educate clients on proprietary products when necessary

· Anticipate client needs.

· Motivate employees.

· Effectively handle employee relations issues.

· Manage multi-functional teams.

· Knowledge of insurance and medical terminology.

· MS Office and related applications.

· Client proprietary systems

· Coaching and team building.

· Industry trends.



· Bachelor’s degree (B.A. or B.S.) from a four year college or university and/or four years related experience and/or training in Healthcare, PPO networks, payer administration, etc.

· Direct management experience especially of teams in remote locations.



· Travel requirements to (primarily) domestic destinations should not exceed 25%.


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