Client Services Specialist (Healthcare Benefits) - Fully Remote

POSITION SUMMARY 

The Client Service Representative delivers responsive, accurate, and professional service to Allied clients, including employer and HR representatives, brokers, and other benefit plan partners. Serving as a primary point of contact, this role owns client inquiries from initial request through resolution, coordinates with internal departments, and provides clear, timely follow-up. The position supports a positive client experience by demonstrating strong knowledge of medical claims, sound judgment, attention to detail, and a consistent commitment to service excellence. 

WORK SCHEDULE 

• Training schedule: 8:00 a.m. to 4:30 p.m. Central Time for the first six weeks of employment. 

• Regular schedule after training: 10:30 a.m. to 7:00 p.m. Central Time. 

• Consistent availability during the assigned schedule is required to support clients and business needs. 

ESSENTIAL FUNCTIONS 

• Serve as the primary liaison between clients and brokers and the Allied executives and departments that support the benefit plan. 

• Manage client inquiries and service issues from receipt through resolution, providing timely, accurate, professional, and courteous communication. 

• Research claim-related questions, coordinate with Claims, Eligibility, Account Management, and other internal teams, and clearly communicate outcomes and next steps. 

• Promptly escalate client complaints, service concerns, and unresolved issues to the appropriate department while maintaining ownership of follow-up. 

• Provide clients and brokers with updates regarding claim issue resolution, reporting, relevant industry developments, and legislative information as directed. 

• Support Account Managers by assisting with client communication, claim reviews, reporting needs, issue tracking, and follow-up activities. 

• Complete month-end follow-up by reviewing and closing open claim issues and documenting final resolutions. 

• Build collaborative relationships across Claims, Eligibility, Account Management, and other internal teams to promote efficient service delivery. 

• Identify recurring service issues and process gaps, recommend improvements, and partner with internal departments to strengthen the client experience. 

• Support retention and renewal efforts for existing clients through effective management of claim reviews, open issues, and service-level expectations. 

• Maintain complete, accurate, and timely documentation of client interactions, issues, resolutions, and required follow-up. 

• Protect confidential member, client, and benefit plan information and follow applicable privacy, security, and departmental procedures. 

• Perform other duties and special projects as assigned. 

EDUCATION 

• High school diploma or GED required. 

• Associate or bachelor's degree preferred. 

EXPERIENCE AND SKILLS 

• At least one year of medical claims experience required. 

• Hands-on experience and working knowledge of HCFA/CMS-1500 and UB-04 medical claims, including CPT codes, required. 

• Experience researching, processing, or resolving medical claims strongly preferred. 

• Previous client service or customer service experience in healthcare, benefits administration, insurance, or a related environment preferred. 

• Working knowledge of medical claims terminology, claim status, benefit plan administration, and issue-resolution processes. 

• Strong client service skills with the ability to remain professional, empathetic, and solution-focused during complex or sensitive interactions. 

• Excellent verbal and written communication skills, including the ability to explain claim information and next steps clearly to clients and brokers. 

• Strong analytical and problem-solving skills with the ability to research issues, identify root causes, and coordinate appropriate resolution. 

• Excellent organizational skills, attention to detail, and follow-through. 

• Ability to manage multiple priorities, meet deadlines, and maintain accuracy in a fast-paced and occasionally stressful environment. 

• Ability to work independently while collaborating effectively with cross-functional teams. 

• Intermediate proficiency with Microsoft Office applications, including Word, Excel, Access, and PowerPoint, required. 

• Experience with web-based applications required. 

• Experience with the RIMS claim processing system preferred. 

POSITION COMPETENCIES 

• Accountability and Ownership 

• Clear and Professional Communication 

• Client Service Orientation 

• Claims and Technical Knowledge 

• Collaboration and Relationship Building 

• Problem Solving and Judgment 

• Quality and Attention to Detail 

• Time and Task Management 

PHYSICAL DEMANDS 

• This is a standard desk-based role that requires extended periods of sitting, computer use, and telephone or virtual communication. 

• Reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position. 

WORK ENVIRONMENT 

• Remote work environment. 

• The employee must maintain a professional workspace with reliable internet access and the ability to protect confidential information.