Client Support Specialist

As a Client Support Specialist, you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members.

Responsibilities:

Handle Day-to-day Inquiries from Group Contacts:

• Support Senior Account Manager with requests as needed.
• Coordinate with internal teams for resolution around day-to-day inquiries from the group and escalate with Senior Account Manager as necessary: Claims issues – processed incorrectly, delay in processing, etc., eligibility – discrepancies in active participants, group requests for updates (admin errors, etc.), Rx issues – coordinate with PBM to resolve member issues with medications and/or close out problems sent out on Rx Issue Report, Escalated member issues – member service concerns, UR denials, etc., Assist with ID card inquiries/issues, Work with Client Resolution Manager to complete RCA (Root Cause Analysis) when issue appears to have larger impact.
• Assist groups with MESA and STS client issues.
• Participate in new group implementation meetings.
• Assist with OE meetings/benefit fairs (as needed)
• Handle general billing questions from group – understand and navigate TPA Stream as necessary to answer questions.

Handle General Reporting Needs:

• Request and send SOC 1 reports, Schedule A & C reports.
• Run Alegeus FSA/HRA reports as needed.
• Pull & send general reports out of report manager – census, HCC, etc.
• Distribution of annual reports to clients: Medicare D, 1099, 1095, etc.

Administrative Tracking and Upkeep:

• Update issue log with new items daily.
• Track notable claims - reworked/reimbursements/VIP claims.
• Review monthly denied claims report – alert Account Manager of any trends/outliers.
• Manage distribution and collection of COB & Work Status forms when requested by SL.
• Track HIPAA/PHI forms, update Salesforce.
• Monitor daily report of outstanding invoices/RFFs and follow up with group for payment.
• Track OE eligibility, ID card release (for full records).

Overall Group QA:

• Develop & follow monthly QA process for existing/new groups to catch issues early and prevent larger impact to group.
• First level review of case notice for accuracy.
• First level review of monthly admin bill for accuracy.

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