Client Setup Analyst
The Client Setup Analyst is responsible for setting clients up in the group setup and benefit administration system. This includes new sales, renewal changes, cancellations, and maintenance of the client’s account setup. The Client Setup Analyst investigates and resolves client setup issues.
- Setup groups in the group and benefits administration systems, including medical, pharmacy, dental, and vision benefits.
- Communicate with Sales or Brokers to understand the client’s benefits purchase and execute the setup.
- Handle internal processes, including but not limited to reviewing customer records for accuracy to process the groups, re-entry of improper input into the system and
resolution of any other operational or internal systems issues that may arise - Understanding of corporate and departmental policies and procedures
- Responsible for making the determination, based on information gathered, that the case can be accepted and forwarded for processing, or requires further review
- Conform with the plans, policies, and procedures established by Sales management all Underwriting guidelines are met, rate quotes are correct, and determine if additional underwriting is required
- Determine that new clients meet new sale underwriting guidelines and set clients up in the system
- Understand renewal change requested by the client and execute change in the system
- Execute cancellations and maintenance of a group account
- Inform Enrollment and Billing teams of enrollment and billing actions needed
- Investigate and resolve client setup issues in core platform systems I
- Investigate and resolve pharmacy setup issues. Resolve access to care for members in the pharmacy benefit system
- Partner with benefit administration vendors to investigate and resolve issues
- Meet departmental production and quality requirements
- Prepare quality control documentation submitted to the processing areas for group set-up and changes
- Develop and maintain a strong business relationship with the internal customers of the IBC Family of Companies, including but not limited to, Underwriting, Sales,
- Marketing, Enrollment, Customer Service, and any other areas involved in the process.
- Responsible for broker setup. Connect the client groups to the correct broker in the broker commissions system.
- Resolve broker setup discrepancies and address the broker inquiries and concerns
- Research and resolve group setup issues for medical, pharmacy, dental, and vision benefits
- Resolve problems, identify trends, and educate customers as needed
- Perform quality audit of all documentation provided for group/customer set-up and coordinate missing materials when needed
- Audit all incoming materials and maintain complete documentation in regard to issue resolution for broker community, external clients and the departments
- Handle errors and internal/external issues in a timely and effective manner to maintain turnaround times for completion of customer/group set-up
- Provide technical assistance and guidance to Sales and other areas relative to the new business enrollment process implementation of new groups, new customers, benefit changes, group structure and general customer issues
- Responsible for implementation of new groups, benefit changes and cancellations
- Understand customer requirements, document issues or tasks and work closely with Sales to meet customer expectations
- Research and troubleshoot benefits and any other issues related to group set-up
- Represent the Client Setup team in cross-functional internal and vendor meetings
- Perform additional duties as assigned
- Associate degree required, Bachelor’s degree preferred, or must have 2-3 years relevant
experience - Excellent time management and organizational skills required. Ability to prioritize workload and meet
deadlines in a fast paced environment with some supervision. Flexibility and adaptability is a must. - Willingness to be cross trained is required to assist other team members.
- Strong communications skills required – position interacts with all levels of management and may communicate with external clients as well. Must be a strong problem-solver and be able to follow-up and take an issue to resolution.
Aptitude to understand benefits and Underwriting rating methodology. Some critical thinking skills; Capability to understand Underwriting guidelines and apply them. - High level of technical aptitude required - ability to use Microsoft Office and to learn
proprietary and vendor systems. - High level of professionalism is necessary to progress.
- Minimum 2-3 years relevant experience required
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.