- Maintain proper internal controls and risk management with respect to membership processing & reconciliation, billing, and claims processing. o Maintain the integrity of membership data in the eligibility system. o Has an analytical responsibility for resolution of member eligibility, claim and billing discrepancies. o Responsible for ensuring constituent satisfaction, with creative thinking and quick response & resolution. o Maintain a working knowledge of systems that include the claims and eligibility system, and constituent facing systems (Exclaim, , member web, Call Center interface). - Effectively manage client initiatives including: o Overall management and execution of specific client operational projects: define scope, create project timeline with defined key deliverables, negotiate and complete business requirements, drive resolution of non-standard requests, and communicate status of outstanding issues to Client leadership teams. o Provide complete and timely communication and reporting to manager related to client projects in process. o Comply with standards of administration as defined by functional areas. Responsible for meeting deadlines as defined by clients and various functional areas. - Drive client satisfaction: o Lead the post-implementation operational support of operations issue resolution. o Analyze, report and drive for resolution of membership, billing, and claims processing trends with the goal of improving effectiveness. o Participate in client meetings to ensure understanding of client needs and provide operational guidance. o Develop and maintain relationships with clients on multiple levels and across business lines - Drive Key Performance Indicators: o Ensure client operational changes are implemented for cross functional and client satisfaction. o Ensure backup plans are developed and implemented to effectively respond to unplanned situations within standards.
Minimum (Required) Qualifications: - Bachelor’s Degree or equivalent experience - 3 years client-facing experience - 2 years’ experience in an operational liaison role - Strong B2B customer service focus - Strong written and verbal communication skills - Ability to troubleshoot, analyze and problem solve on projects and data issues - Ability to work well independently, under pressure and multi-task - Knowledge of Microsoft, including advanced MS Excel and MS Access - Knowledge of query reporting and large scale data analysis