TPA Account Manager

OneVeracity; Kennesaw (GA); On-site; USD 90,000 - 120,000; Full time

Job summary

OneVeracity is seeking an experienced TPA Account Manager to oversee client and broker relationships and deliver proactive, high-quality service. You will know each account, monitor claims and costs, and lead strategic reviews to drive renewal decisions and client satisfaction.

You will coordinate cross-functional teams, monitor performance across vendors and networks, and own client outcomes while seeking opportunities to grow services and improve cost efficiency.

Qualifications

• Experience in account management, client services, employee benefits, healthcare, TPA, PBM, insurance.
• Strong communication, organization, analytical, presentation and problem-solving skills.
• Ability to travel as needed for client meetings.
• Experience with self-funded health plans and cost-containment programs is a plus.

Responsibilities

• Own assigned client relationships and understand key contacts, goals, concerns, plan design, funding, renewal timing.
• Build trusted relationships with clients and brokers and maintain proactive communication.
• Understand claims, PMPM, trend, utilization, high-cost claims and major cost drivers.
• Monitor RBP/network performance and address provider issues and enrollment.
• Monitor pharmacy, clinical, vendor performance and identify cost improvement opportunities.
• Own the client outcome for issues and escalations, even when another team solves it.
• Coordinate internal teams to ensure ownership, timelines and follow-up.
• Proactively communicate material concerns before they escalate.
• Lead quarterly and strategic reviews explaining outcomes and next steps.
• Prepare for renewals by reviewing performance and opportunities for the next year.
• Support retention and account growth by identifying client needs.
• Maintain accurate CRM, reporting and account information.
• Identify recurring issues and share feedback with leadership.
• Mentor Account Associates and junior managers as appropriate.

Skills

Account management

Client services

Employee benefits

Healthcare

TPA

PBM

Insurance

Communication

Organization

Problem solving

Presentation

Travel readiness

Job description

Description

The TPA Account Manager owns the overall client and broker relationship and is responsible for delivering proactive, high-quality client experience. The TPA Account Manager should know the account, understand the numbers, identify issues early, and bring recommendations and solutions.

• Own assigned client relationships and understand key contacts, goals, concerns, plan design, funding, stop-loss, network/RBP, pharmacy, vendors and renewal timing.
• Build trusted relationships with clients and brokers and maintain clear, proactive communication.
• Understand claims, PMPM, trend, utilization, high-cost claims and major cost drivers; explain what changed, why it changed and what it means.
• Monitor RBP/network performance, balance bills, provider issues, member experience and dual-option enrollment and performance when applicable.
• Monitor pharmacy, clinical, vendor and operational performance and identify opportunities to improve cost, plan performance or member experience.
• Own the client outcome for issues and escalations, even when another team owns the technical solution.
• Coordinate internal teams to ensure issues have clear ownership, timelines and follow-up.
• Proactively communicate material claims, member, network, vendor, eligibility, reporting or compliance concerns before they become escalations.
• Lead quarterly and strategic reviews that explain what happened, why it happened, what it means and what should happen next.
• Prepare for renewals early by understanding account performance and recommending opportunities for the next plan year.
• Support retention and account growth by identifying client needs and opportunities to expand or improve services.
• Maintain accurate CRM documentation, reporting and account information.
• Identify recurring issues and process improvements and share client feedback with leadership.
• Mentor Account Associates and less-experienced Account Managers as appropriate.

Account Manager/ Account Associate Partnership

• Account Associate: executes, tracks, researches, coordinates, documents and follows up.
• Account Manager: directs, prioritizes, interprets, strategizes, communicates, escalates and owns the outcome.

Requirements

• Experience in account management, client services, employee benefits, healthcare, TPA, PBM, insurance or a related field.
• Experience managing client relationships and multiple priorities.
• Strong communication, organization, analytical, presentation and problem-solving skills.
• Ability to work cross-functionally and take ownership of outcomes.
• Ability to travel as needed for client meetings

Preferred

• Experience with self-funded health plans, RBP, network products, pharmacy benefits or cost-containment programs.
• Experience interpreting claims and utilization reporting.

Key Competencies

• Client relationship management and strategic account management
• Proactive communication and responsiveness
• Claims and financial understanding
• Problem solving and issue resolution
• Accountability and ownership
• Cross-functional collaboration
• Organization and attention to detail
• Presentation and communication skills
• Ability to identify risks and opportunities