Client Experience Manager - Medicare Advantage

What are important things that YOU need to know about this role?

• Open to permanently remote candidates

• Schedule: Candidates can be based anywhere in the United States, but must be open to working Pacific Time Zone as needed

• Travel: some travel is required to our office in Menomonee Falls.  At a minimum of once per quarter, travel to the client is required.

• Significant understanding of Medicare Advantage is required.  Knowledge of CMS regulations is required as well.

What will YOU be doing for us?  The Client Experience Manager – Medicare Advantage is responsible for ensuring client satisfaction for Medicare Advantage clients, which includes monitoring account performance, overseeing all aspects of contract performance, and service requests, including resolving customer concerns. Responsible to ensure effective implementation and onboarding of initial client and subsequent new markets and products/services. Partner with client in the development of program/sequence of on-boarding additional clients. Maintain effective relationships with client operational leaders to ensure positive client references and client renewals, facilitate effective resolutions to issues, and identify potential opportunities for additional business. Coordinate messaging to the client as it relates to service requests, service issues, and CAPS.  Expected to be an expert in client contracts and responsible for adherence to the client request process. (The term ‘clients’ referenced throughout this job description refers to the clients specifically assigned to the Service Manager.)

What will YOU be working on every day?

• Primary client liaison and subject matter expert on Medicare Advantage programs. Serve as a reference point for internal staff.

• Partnering with other areas (Chief Strategic Officer) to execute the onboarding of the additional clients

• Using Medicare Advantage knowledge base, responsible for overall client satisfaction by coordinating, preparing and delivering internal client updates, monitoring deliverables and SLAs to be sure commitments are met via tracking mechanisms.

• Has responsibility for overall client service delivery by assigning and directing Account Managers.

• Responsible for messaging to client related to escalated, high profile, or sensitive issues with little input from the Client Experience Executive; provides guidance to Account Managers as needed.

• Primary Liaison to client on service levels, issues, and other detailed information to support delegated work. Coordinate high-level meetings (onsite client visits), ensuring established and published agenda prior to the meeting as well as published, formal meeting notes

• Ensure client requests/deliverables are within contract scope and work with the Client Experience Executive on out of scope items.

• Ensures the client as well as the Account Managers follow the Client Request Process

• Determines any additional workflows and processes needed to supplement the Client Request Process to best service assigned clients and directs Account Managers to carry out these workflows and processes

• Collaborate with other SKYGEN USA teams on the successful development, production and delivery of client deliverables as well as the establishment of process efficiencies to ensure success and low-cost/resources.

• In collaboration with project management, plan and execute the startup of new products and services for the assigned clients; confirm the documentation of client decisions. Responsible to ensure configurations conform with client requirements.

• Develop client relationships through visits and phone calls to resolve and avoid problems. Work closely with internal teams assigned to clients to ensure requests are resolved within appropriate timeframes.

• Work closely with the Client Experience Executive in ongoing account planning as well as to monitor service delivery and client satisfaction with products and services.

• Quantify client activity and outcomes for internal monitoring and reporting.

• Responsible for management of any Account Managers assigned to the Service Manager, e.g., internal and external messaging, navigating internally toward solutions.

• Determines assignments to Account Managers and even distribution of work based on experience and skills (e.g. market assignments, special projects, etc.).

• Ensures work assigned to Account Managers will help develop their skills.

• Identify and evaluate trends in client concerns for suggestions to improve organizational processes. 

• Analyze client surveys with the Client-specific experience team to identify areas for improvement and development of action plans.

Escalated Issues

• Escalation point for Account Manager on all Medicare Advantage high priority issues such as penalties, corrective action plans (CAPs), critical requests, and compliance issues.  Provide advice and direction as needed.

• Works with other SKYGEN managers and directors to resolve escalated issues.

• Participates in and/or direct activities related to responding to CAPs.  Proactively escalates issues related to CAPS, penalty risk, compliance issues, problems, issues and status updates to appropriate parties such as Client Experience Executive, compliance, CFO, and internal department heads.

• Tactfully respond to escalated requests including when there is delay(s) in response, response was not considered satisfactory, or request cannot be met.

Audits

• Oversees Account Managers to ensure a smooth client onsite audit; delegates

• Participate in the determination and implementation of corrective action plans surrounding contractual requirements and perhaps identified in audits.

• In collaboration with the QA staff, document and monitor internal progress on corrective action plans.

Process Improvement

• Maintain knowledge of industry trends to effectively address client concerns.

• Keep up with all changes, trends pertaining to Medicare Advantage

• Develops expertise in SKYGEN processes, Enterprise system and other systems to identify areas for continuous improvement goals.

• Identifies prospective client opportunities and share client leads with Client Experience Executive for appropriate follow up.

• Identify potential efficiencies and workflow improvements based on knowledge of industry and internal business practices.

What qualifications do YOU need to have to be GOOD candidate?

• Require Level of Education

  • Bachelor’s degree in Business or other related field or equivalent years of related experience

• Required Level of Experience

  • 5+ years previous experience acting as primary contact for service concerns for large health insurance clients.

  • At least 3 years prior experience working cross-functionally in government programs with experience in Medicare Advantage.

  • 1-3 years of training peers, or mentoring

  • Experience in complex project management in regulatory environments.

• Required Knowledge, Skills and Abilities

  • Solid knowledge base of managed care, especially with Medicare Advantage plans (CMS rules/regulations).

  • Demonstrated conflict management skills; well-honed communication skills and ability to hold others accountable.

  • Demonstrated ability to learn and work in complex environments with a continual learning approach.

  • Ability to navigate potential internal and/or external roadblocks and negotiates obstacles; influence stakeholders as appropriate; seeks compromise when necessary

  • Solid administrative skills in the areas of  project planning, organizing and time management

  • Ability to travel quarterly.

  • Strong knowledge of Microsoft office products (Excel, Word, and email) at an intermediate level.

  • Ability to manage multiple priorities and ensure timelines and deadlines are met. 

  • Ability to communicate and work with a diverse group of internal and external individuals from administrative to c-suite.

  • Ability to effectively understand the industry and organization’s products/services and apply appropriately.

  • Effective communication skills both in person and in written documents.

  • Ability to effectively present thoughts and respond to questions in a public speaking opportunity.

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, License, and/or Certificates

  • Bachelor’s degree in Business, Marketing, or other related field of study

  • Project Management Experience

• Preferred Knowledge, Skills, and Abilities

  • Preferred experience in health care insurance operations and/or servicing large health insurers  

  • Knowledgeable of various dental and health care products.

  • Expertise in various areas of the Enterprise system

  • Workflow optimization for efficiency and potential cost savings

  • Knowledgeable of medical terminology, procedures, and CDT procedure coding.

  • Basic SQL and relational database knowledge

The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range:

Compensation Midpoint: