Client Business Manager

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Facilitate client success through onboarding, operational assistance, and service delivery.

• Interact virtually with clients, health plans, and internal teams.

• Oversee onboarding, continuous operational support, and service delivery from the go-live phase to steady state.

• Establish and nurture relationships with client administrators, network providers, and management teams.

• Manage delegated service delivery across Eligibility, non-clinical UM, PHM, Claims, Quality, CX, and Credentialing/Provider Relations.

• Serve as the primary accountability owner for the performance of delegated functions.

• Ensure compliance with regulatory standards and contractual obligations.

• Prepare monthly reports for delegated services and quarterly materials for executive reviews.

• Assist with URAC, HCAPA, and health plan pre-delegation audit preparations.

• Monitor, analyze, and report operational data and performance metrics on a monthly basis.

• Identify trends and resolve issues across internal functions.

• Manage eligibility, capitation, and reconciliation processes, addressing discrepancies with Finance and Eligibility.

• Contribute to implementations for new clients, scope expansions, platform transitions, network developments, and accreditation renewals.

• Monitor SLA performance against contractual requirements and drive necessary remediation.

• Lead operational meetings with clients and participate in UM committees, JOCs, and monthly closure meetings.

• Conduct client check-ins, satisfaction reviews, and quarterly business reviews at the executive level.

• Track CSAT and NPS in relation to annual targets.

• Manage escalations involving claim denials, authorization issues, eligibility inquiries, provider complaints, roster discrepancies, payment issues, and other operational challenges.

• Support contract renewals, including SLA restructuring, PMPM negotiation input, scope expansion proposals, and BAA updates.

• Represent Guidehealth at BCBSIL forums, translating regulatory and program changes into actionable operations.

• Maintain documentation for client contracts, DORs, SOWs, and SLA schedules.

• Contribute to initiatives aimed at operational improvement, such as reducing paper claims, adopting EFT/ERA, minimizing out-of-network costs, and addressing denial workflows.

• Utilize EMR systems, payer portals, Guidehealth applications, and Microsoft 365.

• Collaborate with internal teams to provide integrated services and ensure a consistent client experience.

⛳️ Requirements

• Associate degree or equivalent experience is considered.

• A minimum of 3 years of experience in healthcare operations, managed care, IPA operations, health plan operations, or a related field.

• Proven experience in owning or significantly contributing to client-facing operational tasks with accountability for results.

• Excellent verbal and written communication skills.

• Capability to actively listen, conduct structured client meetings, and communicate effectively with clients, health plan partners, and cross-functional teams.

• Strong organizational skills with the ability to manage multiple workstreams, deadlines, and deliverables.

• Strong analytical skills and problem-solving abilities.

• Proficient in managing a client portfolio and competing priorities independently in a fast-paced environment.

• Proficiency in Microsoft 365, including Excel, Word, PowerPoint, Outlook, and Teams.

• Ability to learn various systems.

• Valid driver’s license and reliable transportation.

• Willingness to travel 25% within the Chicago area.

• Preferred direct experience in delegated services, including UM, Claims, Credentialing, Eligibility, PHM, Quality, or CX.

• Familiarity with value-based care contracts, shared savings, full risk, capitation, and PMPM service arrangements is preferred.

• Experience with SLA tracking, compliance reporting, and health plan or NCQA/URAC audit preparation is preferred.

• Knowledge of claims workflows, 834 eligibility files, capitation reconciliation, and payer portals is preferred.

• Experience in presenting operational and executive-level reports to client leadership is preferred.

• Basic understanding of EMR systems and healthcare data platforms is preferred.

• Employees must provide an internet connection with a minimum of 100 Mbps download and 10 Mbps upload speeds.

• Employees are required to be accessible during designated working hours and participate in virtual meetings with their cameras on.

• Adherence to security policies and procedures to protect PHI, PII, and Guidehealth intellectual property is mandatory.

🏝️ Benefits

• Fully remote work arrangement.

• Necessary work equipment provided at no cost.

• Medical, dental, and vision insurance plans.

• 401(k) plan with a 3% employer match on the employee's 6% contribution.

• Life and disability insurance.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Access to learning and development resources.

• Flexible work-from-home arrangements.

• Full-time employees working 30 or more hours per week are eligible for comprehensive benefits.