Client Business Manager

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

📋 Description

• Assist in ensuring client success by facilitating client onboarding, providing operational support, and delivering services.

• Interact virtually with clients, health plans, and internal teams in a fully remote setting.

• Take ownership of the onboarding process, ongoing operational support, and service delivery from the go-live phase to steady state.

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

• Oversee delegated service delivery in areas such as Eligibility, UM, PHM, Claims, Quality, CX, and Credentialing/Provider Relations.

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

• Ensure adherence to regulatory requirements and contractual obligations.

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

• Assist in preparing for URAC, HCAPA, and health-plan pre-delegation audits.

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

• Manage eligibility, capitation, and reconciliation processes, resolving any discrepancies with Finance and Eligibility teams.

• Contribute to client implementations, scope expansions, platform transitions, network development, and accreditation renewals.

• Track SLA performance, identify gaps, drive corrective actions, and communicate status updates to clients and leadership.

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

• Conduct client check-ins, satisfaction assessments, and quarterly executive business reviews.

• Monitor CSAT and NPS metrics against annual objectives.

• Handle escalations related to claim denials, authorization concerns, eligibility, provider complaints, roster discrepancies, and payment issues.

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

• Represent Guidehealth at BCBSIL forums and translate regulatory and program changes into operational actions.

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

• Contribute to initiatives aimed at operational improvements.

• Manage daily tasks utilizing EMR systems, payer portals, Guidehealth applications, and Microsoft 365.

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

⛳️ Requirements

• Bachelor's degree is preferred; an Associate degree or equivalent experience will be considered.

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

• Demonstrated experience in owning or significantly contributing to client-facing operational work, with accountability for results.

• Excellent verbal and written communication skills.

• Strong organizational abilities and proficiency in managing multiple workstreams, deadlines, and deliverables.

• Solid analytical and problem-solving capabilities.

• Capability to independently manage a client portfolio and prioritize competing tasks in a fast-paced setting.

• Proficient in Microsoft 365 (Excel, Word, PowerPoint, Outlook, Teams).

• Willingness to learn and navigate multiple systems.

• Possession of a driver’s license and reliable transportation.

• Ability to travel 25% within the Chicago area.

• Direct experience with delegated services is preferred.

• Familiarity with value-based care contracts and PMPM service arrangements is preferred.

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

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

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

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

• Ability to work during specified working hours and maintain an internet connection of at least 100 Mbps download and 10 Mbps upload.

🏝️ Benefits

• Fully remote work arrangement.

• Comprehensive Medical, Dental, and Vision plans.

• 401(k) plan with a 3% employer match for 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.

• Resources for learning and development.

• Necessary work equipment provided at no cost.

• Commitment to equal opportunity employment.