Account Manager - Healthcare TPA

Job Description

Job Description

Role Title: Account Manager - Healthcare TPA

Reports to: Director, Account Management

Location: FL or GA

Position Summary:

The Account Manager serves as the primary point of contact between FirstEnroll (a healthcare TPA) and its clients, ensuring the smooth delivery of services while maintaining strong relationships. This role involves understanding client needs, providing timely support, resolving issues, and identifying opportunities for business growth.

KEY RESPONSIBILITIES

Client Relationship Management:

• Act as the main liaison between clients (employers, insurers, or brokers) and the TPA.
• Build and maintain strong relationships with key stakeholders, ensuring a high level of client satisfaction.
• Conduct regular check-ins and meetings with clients to review performance, address concerns, and provide updates on services.

Account Management:

• Oversee the end-to-end administration of client accounts, including onboarding, plan setup, and policy renewals.
• Ensure compliance with service-level agreements (SLAs) and timely resolution of client issues or escalations.
• Monitor and analyze client utilization trends, claims data, and feedback to identify areas for improvement.

Service Delivery and Coordination:

• Collaborate with internal teams (claims processing, network management, customer service, etc.) to ensure seamless service delivery.
• Provide training or education to clients and their employees on healthcare plans, claim processes, and benefits.
• Coordinate wellness programs, health camps, or other initiatives as part of client engagement.

Business Development and Retention:

• Identify opportunities to expand service offerings, cross-sell, or up-sell additional TPA solutions to existing clients.
• Assist in preparing and delivering proposals or presentations for contract renewals.
• Work to retain accounts by proactively addressing potential client dissatisfaction and presenting value-driven solutions.

Reporting and Compliance:

• Prepare and deliver periodic performance reports, claims analysis, and utilization summaries to clients.
• Ensure all activities and communications comply with relevant healthcare regulations and industry standards.
• Keep records of client interactions, agreements, and feedback in the CRM system.

Industry Expertise:

• Stay updated on industry trends, regulations, and best practices in healthcare and insurance.
• Provide insights and recommendations to clients based on market developments.

KEY SKILLS AND COMPETENCIES

• Strong interpersonal and communication skills, with the ability to build rapport and trust.
• Excellent organizational and time-management abilities to handle multiple accounts effectively.
• Problem-solving skills with a focus on delivering client-centric solutions.
• Analytical skills to interpret data and trends, providing actionable insights.
• Ability to collaborate across teams and manage cross-functional relationships.
• Knowledge of healthcare benefits, claims processing, and insurance products is preferred.

QUALIFICATIONS AND EXPERIENCE

• Bachelor’s degree in healthcare administration, business, or a related field.
• 3+ years of experience in account management, client servicing, or a related role, preferably in the healthcare or insurance industry.
• Familiarity with TPA operations, health insurance policies, and claims processes is a plus.
• Current or prior licensed agent experience a plus.
• Proficiency in CRM tools and MS Office Suite (Excel, PowerPoint, Word).

KPIs (KEY PERFORMANCE INDICATORS)

• Client satisfaction score (NPS or equivalent).
• Retention rate of client accounts.
• Timeliness and quality of service delivery.
• Growth in revenue from existing accounts.
• Resolution time for client issues and escalations.