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Centivo · 3 months ago

Client Operations Specialist

United States

Full-time

Remote

Senior Level

$60K/yr - $65K/yr

5+ years exp

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. The Client Operations Specialist plays a vital role in supporting the Client Success team by managing health insurance services and ensuring that client needs are met through process optimization and effective communication.

Health CareInformation TechnologyMedical

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 inquires 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

Identify issue impact and communicate root causes and resolution steps clearly to client success

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

Qualification

Health insurance productsData reportingJIRAProject managementSQLTableauMS OfficeCustomer serviceCommunication skillsOrganizational skills

Required

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-orientated 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