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.