POSITION SUMMARY

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.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

• High School Diploma
• 2-3 years experience in insurance industry
• Professional verbal and written communication skills required
• Must be friendly, approachable, professional and service-oriented
• Strong knowledge of commonly used concepts, practices and procedures within the insurance field
• Medical claims processing preferred
• Effective organizational and proactive thinking skills
• Proactive thinking a must
• Knowledgeable with stop loss, and self-funded and/or level-funded accounts
• WLT expertise

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

DUTIES AND RESPONSIBILITIES

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

• Provides professional, friendly and thorough customer service to all external and internal customers via email and
• telephonically.
• Works to build and maintain positive rapport and relationships with all external and internal customers.
• Researches and follows up on a variety of issues and requests until resolved/completed. Issues and requests include but are not limited to claims status and education, EOB requests, plan document interpretation, claims reprocessing, special claims arrangement (SCA) processing requests, provider outreach calls, balance billing education, claims reporting and more.
• Collaborates with ABA departments such as Accounting, Stop Loss, Eligibility, Drug Invoices, Account Management and other departments as needed.
• Provides consistent communication and updates on issues and questions, including initial acknowledgment within 24 business hours of receipt, and resolution or status update within 48 business hours of receipt.
• Maintains current issue resolution log for each client using professional terminology, format, grammar and punctuation so that it may be shared externally. Must be able to provide updated status at any time on open issues.
• Proactively reviews issues to identify possible account set-up errors as well as common trends amongst clients and overall book of business and communicates these to Account Executive. Makes recommendations to resolve and works with Account Executive to assist with resolution as needed.
• Collaborates with Account Executive on ways to improve account service and volume.
• Provides education to all internal and external customers on claims/benefit guidelines, procedures and best practices, including advisement on out-of-contract requests that may impact stop loss coverage.
• Serves as subject matter expert on calls with external and internal customers.
• Monitors claim accuracy and identifies common trends in claim processor errors. Provides coaching and mentoring to Claim Processors as needed.
• Oversees special client-specific claim projects and non-standard workflows to ensure accuracy and success.
• Works with Customer Service team to request member outreach calls when needed and follows up to ensure outreach has been completed.
• Audits claims for assigned accounts as requested by Account Executive or internal team members.
• Monitors claims backlog for assigned accounts/book of business and alerts internal staff of delays.
• Provides temporary ID cards when requested.
• Coordinates portal access and training with Vendor Management team for clients and brokers.

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

• May perform other duties as required.