Manager of Client Services - Government ProgramsVERACITY BENEFITS • Kennesaw, GA, US
Manager of Client Services - Government Programs
VERACITY BENEFITS • Kennesaw, GA, US
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job_description.job_card.job_descriptionBachelor’s degree in healthcare administration, social work, business, or related field (or equivalent experience). 5+ years of experience in health insurance, PBM, TPA, or healthcare services with a strong focus on Medicare, Medicaid, and other government programs . In-depth knowledge of CMS regulations, state program guidelines, and federal health benefit requirements. Strong communication and problem-solving skills, with a member-first approach. Experience handling escalated or complex member cases with empathy and professionalism. Ability to manage multiple priorities in a fast-paced environment while ensuring accuracy and compliance. Familiarity with pharmacy benefits and prior authorization processes. Experience working with TPAs, PBMs, or integrated health plans.
Job Description
Job Description
Description : Overview
We are seeking a knowledgeable and compassionate professional with expertise in Medicare, Medicaid, and other federal and state health programs to serve as a key point of contact for our members and clients. This role is dedicated to ensuring members have the support they need to navigate coverage, benefits, and prior authorization processes, while also partnering with clients to deliver exceptional service.
Responsibilities
- Serve as the primary point of contact for members and clients regarding Medicare, Medicaid, Marketplace, and other federal or state program benefits.
- Provide guidance and education to members on coverage, eligibility, enrollment, and appeals processes.
- Assist members with navigating prior authorizations, claims, and billing issues, ensuring timely resolution and clear communication.
- Collaborate with providers, pharmacies, and internal teams to address and resolve complex benefit and coverage questions.
- Monitor changes in federal and state program regulations to ensure compliance and keep stakeholders informed.
- Develop and maintain strong relationships with clients, ensuring a high level of satisfaction and trust.
- Track and analyze member issues to identify trends and recommend process improvements.
Requirements : Qualifications
Preferred Skills
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Client Service Manager • Kennesaw, GA, US