About the role
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 Manager/ Account Associate Partnership
Account Associate: executes, tracks, researches, coordinates, documents and follows up.
Account Manager: directs, prioritizes, interprets, strategizes, communicates, escalates and owns the outcome.
Requirements
- 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
Preferred
Experience with self-funded health plans, RBP, network products, pharmacy benefits or cost-containment programs.
Experience interpreting claims and utilization reporting.
Key Competencies
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