TPA Account Manager

Description

The TPA Account Manager owns the overall client and broker relationship and is responsible for delivering proactive, high-quality client experience. The TPA Account Manager should know the account, understand the numbers, identify issues early, and bring recommendations and solutions.

• Own assigned client relationships and understand key contacts, goals, concerns, plan design, funding, stop-loss, network/RBP, pharmacy, vendors and renewal timing.
• Build trusted relationships with clients and brokers and maintain clear, proactive communication.
• Understand claims, PMPM, trend, utilization, high-cost claims and major cost drivers; explain what changed, why it changed and what it means.
• Monitor RBP/network performance, balance bills, provider issues, member experience and dual-option enrollment and performance when applicable.
• Monitor pharmacy, clinical, vendor and operational performance and identify opportunities to improve cost, plan performance or member experience.
• Own the client outcome for issues and escalations, even when another team owns the technical solution.
• Coordinate internal teams to ensure issues have clear ownership, timelines and follow-up.
• Proactively communicate material claims, member, network, vendor, eligibility, reporting or compliance concerns before they become escalations.
• Lead quarterly and strategic reviews that explain what happened, why it happened, what it means and what should happen next.
• Prepare for renewals early by understanding account performance and recommending opportunities for the next plan year.
• Support retention and account growth by identifying client needs and opportunities to expand or improve services.
• Maintain accurate CRM documentation, reporting and account information.
• Identify recurring issues and process improvements and share client feedback with leadership.
• Mentor Account Associates and less-experienced Account Managers as appropriate.

• Account Associate: executes, tracks, researches, coordinates, documents and follows up.
• Account Manager: directs, prioritizes, interprets, strategizes, communicates, escalates and owns the outcome.

• Experience in account management, client services, employee benefits, healthcare, TPA, PBM, insurance or a related field.
• Experience managing client relationships and multiple priorities.
• Strong communication, organization, analytical, presentation and problem-solving skills.
• Ability to work cross-functionally and take ownership of outcomes.
• Ability to travel as needed for client meetings

• Experience with self-funded health plans, RBP, network products, pharmacy benefits or cost-containment programs.
• Experience interpreting claims and utilization reporting.

• Client relationship management and strategic account management
• Proactive communication and responsiveness
• Claims and financial understanding
• Problem solving and issue resolution
• Accountability and ownership
• Cross-functional collaboration
• Organization and attention to detail
• Presentation and communication skills
• Ability to identify risks and opportunities