Client Operations Specialist

Centivo • Buffalo, NY

77d

About The Position

The Client Operations Specialist plays a vital role in supporting our Client Success team with the end-to-end delivery of health insurance services for employer groups, brokers, and individual members. This position acts as a conduit between Client Success and the broader Centivo organization, helping to ensure that market facing needs and requirements are being accounted for in our day-to-day operations or broader projects that will impact the market facing team. The ultimate objective of the Client Ops team is to reduce the administrative & operational burden of our Client Success teams through standardization and process optimization.

Requirements

• Experience working with health insurance products (HMO, PPO, HDHP, etc.), funding types (fully insured, ASO, Level Funded), and regulations (ACA, HIPAA).
• Strong organizational and project management skills.
• Proficiency with MS Office (Excel, Outlook, Word).
• Excellent written and verbal communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Holds high Customer Service standards and aims to be client-oriented with a drive for quality service.
• 5 years of experience in health insurance, healthcare, or employee benefits, preferably in a client-facing or operational role.
• Must have worked in a TPA or direct carrier setting.
• Experience working in JIRA, SQL and Tableau.

Nice To Haves

• Bachelor's Degree.
• Experience working with self-funded healthcare plans.
• Knowledge of claims administration, billing cycles, and eligibility system.
• Experience with CRM’s and health plan administration systems.

Responsibilities

• Act as Subject Matter Expert, representing the voice of the customer and client success, on any product, network, vendor discussions and rollouts.
• Identify Client Success needs and requirements related to such rollouts, ensuring timely distribution of deliverables to Client Success.
• Support will be expected but not limited to Open Enrollment, Plan Renewals and any plan changes.
• Project management and system support for internal systems (Plan Manager, Portal) will be required of this role.
• Ensure accuracy and integrity of client data in internal systems.
• Monitor KPIs related to client satisfaction, service level agreements (SLAs), and operational performance.
• Alert Client Success if KPI’s are not meeting targets and make recommendations to improve performance.
• Identify inefficiencies in client-facing processes and propose solutions.
• Develop and maintain standard operating procedures (SOPs).
• Partner with all areas of the organization, including but not limited to: Client Success, Account Management, Product, and IT, to ensure consistent delivery of outputs.
• Assist with any broad claims issues when necessary.
• Identify issue impact and communicate root causes and resolution steps clearly to client success, while also working with Communications on external communication if/when necessary.
• Handle client inquiries by collaborating with Claims and Member Care departments to resolve and/or escalate member issues, including VIP member issues with internal Customer Advocacy team.
• Provide timely updates on system changes, process impacts, or service issues/outages.
• Own the intake, tracking, and resolution of broad operational client issues (e.g., file failures, processing delays, network changes, etc).
• Log, track, and resolve escalations by coordinating with internal departments like claims, IT, eligibility, etc.
• Support Client Success with integration of third-party vendors for clients (e.g., PBM, eligibility vendors, point solutions, etc).
• Facilitate internal process including requirement gathering, ticket submission and monitoring.

What This Job Offers

• Number of Employees: 251-500 employees