Client Support Specialist
About The Position
Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States. 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.
Requirements
- High School Diploma or equivalent required.
- 2–3 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.
Nice To Haves
- 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.
Responsibilities
- 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.
- May perform other duties as required.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
