About this role
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.