The Client Services Senior Account Manager is the primary liaison between the claims, customer service, and eligibility vendors, pharmacy benefits management, utilization management, subrogation and Sutter Select. The incumbent is responsible for managing SutterSelect clients remotely by providing accurate and thorough interpretation of the client's medical benefits, claims processes, eligibility and enrollment policies and network access; with responsibility to understand the underpinnings of the client organization structure, their work plan, and day to day operations. The Client Services Senior Account Manager is also responsible for resolving complex member and client inquiries, facilitates problem resolution, and acts as a member and client advocate by meeting or exceeding their expectations. The position provides support and guidance as appropriate to other SutterSelect departments.
The Client Services Senior Account Manager maintains accountability for coordinating monthly reporting responsibilities from third party administrators and provide clients and Operations Director with quarterly reports (or other predetermined timeframes), conducts on-site client visits to review performance of the plan. Client interaction includes, but is not limited to training for the client HR/Benefits team, department meetings, employee sessions, labor bargaining, Open Enrollment and Benefit Fairs representation. Responsible for maintaining productive relations with clients, vendors, colleagues and management, as well as, keeping management fully informed with regards to client direction and focus, along with identification of potential problems.
The Client Services Senior Account Manager assists the Operations Director and the SutterSelect team in creating and maintaining detailed implementation project plans, all ongoing reports, and other documentation throughout implementation and ongoing maintenance of accounts.
· Education:
Bachelor's degree in Communications, Marketing, Business or Health Care related field preferred. An equivalent combination of education and related experience, including health care management, benefits management, and Client/Provider Relations experience will be considered.
- Experience:
· Supervisory or leadership experience in health insurance, benefits, compliance and product operations functions, as would typically be obtained in 10 years of experience
· Experiences developing and maintaining key stakeholder relationships.
· Experience interpreting, analyzing, and dissecting provider contracts, plan benefits, and health insurance guidelines.
· Experience interacting with health care providers.
· Experience working with physician leaders, analyzing, forecasting, interpreting and presenting health care provider performance data.
· Experience designing and implementing solutions to provider issues and problems.
· Knowledge and ability to understand global/national health care issues.
· Experience in the art of negotiating.
· Ability to negotiate win/win outcomes
· Team player and goal oriented individual requiring minimal daily supervision from a remote location
· Knowledge:
· ERISA regulated health plan administration policies and regulations.
· Health and wellness educational concepts, strategies, methods and techniques.
· Current and emerging health issues affecting a specified target populations.
· Excel, Access, Word, Publisher, Outlook and other related software applications.
· Accounting principles and practices.
· Third party reimbursement practices.
· Strong financial acumen around all aspects of self-funded plans including key cost drivers and developing targeted interventions.
· Comprehensive knowledge of health plan operations including claims, member services, regulatory affairs, information systems and medical management.
