Client Business Manager

Summary

Guidehealth is a data-powered healthcare company focused on operational excellence and value-based care. The Client Business Manager supports client success through onboarding, operational support, delegated service delivery, compliance, performance reporting, relationship management, and issue resolution for assigned healthcare clients.

Responsibilities

• Working in a fully remote environment, engaging virtually with clients, health plans, and internal
• Working in a fully remote environment, engaging virtually with clients, health plans, and internal teams
• Owning client onboarding, ongoing operational support, and service delivery for assigned clients, from go live through steady state
• Building and maintaining positive relationships with client administrators, network providers, and management teams to support satisfaction and retention
• Managing the operational delivery of delegated services for assigned clients, including Eligibility, UM (non-clinical), PHM, Claims, Quality, CX, and Credentialing/Provider Relations. Serving as the primary point of accountability for delegated function performance
• Ensuring regulatory and contract compliance across assigned clients. Preparing and delivering monthly delegated services report-outs and quarterly executive review materials. Supporting URAC, HCAPA, and health plan pre-delegation audit preparation
• Tracking, analyzing, and reporting on operational data and performance metrics on a monthly cadence, using Guidehealth’s applications and reporting tools to identify trends and drive issues to resolution across internal functions
• Owning eligibility, capitation, and reconciliation processes for assigned clients, coordinating with Finance and Eligibility to resolve discrepancies
• Contributing to new client implementations, scope expansions, and cross-client initiatives such as platform transitions, network builds, and accreditation renewals
• Tracking SLA performance against contract requirements for every assigned client. Identifying gaps, driving remediation with internal owners, and reporting status to the client and internal leadership. Maintaining 100% SLA compliance as the standing team goal
• Leading client operational meetings and participating in UM committees, JOCs, and monthly close meetings for assigned clients
• Conducting regular client check-ins, satisfaction reviews, and quarterly executive business reviews. Tracking CSAT and NPS against annual targets
• Serving as the escalation owner for claim denials, authorization issues, eligibility questions, provider complaints, roster discrepancies, payment issues, and other client operational issues, driving resolution with the responsible internal team
• Supporting renewal cycles, including SLA restructuring, PMPM negotiation input, scope expansion proposals, and BAA updates. Tracking assigned clients in the Renewals Master Tracker
• Representing Guidehealth at BCBSIL summer and winter forums and translating regulatory and program changes (risk model, MSA, prior auth submissions) into operational actions for assigned clients
• Maintaining accurate client contract documentation, DORs, SOWs, and SLA schedules for the assigned portfolio
• Contributing to team-wide operational improvements, including paper claims reduction, EFT/ERA adoption, OON reduction, 039 denial workthrough, and similar initiatives
• Managing daily work using multiple systems, including EMR systems, payer portals, Guidehealth applications, and Microsoft 365 (Excel, Word, PowerPoint, Outlook, Teams)
• Collaborating with internal teams to deliver integrated services and a consistent client experience

Skills

• Associate degree or equivalent experience considered
• 3+ years of experience in healthcare operations, managed care, IPA operations, health plan operations, or a related field
• Experience owning or contributing meaningfully to client facing operational work, with demonstrated accountability for outcomes
• Demonstrated verbal and written communication skills, including the ability to listen actively, run structured client meetings, and communicate clearly with clients, health plan partners, and cross-functional teams
• Strong organizational skills and the ability to track multiple workstreams, deadlines, and deliverables across a client portfolio
• Strong analytical and problem solving skills, with the ability to work through operational issues across multiple functions and stakeholders
• Ability to manage a portfolio of clients and competing priorities independently in a fast paced environment
• Proficiency in Microsoft 365 (Excel, Word, PowerPoint, Outlook, Teams) and ability to learn multiple systems
• Driver's license
• Bachelor's degree
• Direct experience with delegated services (UM, Claims, Credentialing, Eligibility, PHM, Quality, or CX) in an IPA, health plan, or delegated entity setting
• Familiarity with value based care contracts (shared savings, full risk, capitation) and PMPM based service arrangements
• Experience with SLA tracking, contract compliance reporting, and health plan or NCQA/URAC audit preparation
• Familiarity with claims workflows, eligibility files (834), capitation reconciliation, and payer portals
• Experience presenting operational and executive level reporting to client leadership
• Basic knowledge of EMR systems and healthcare data platforms

Qualifications

Must Haves

• Associate degree or equivalent experience considered
• 3+ years of experience in healthcare operations, managed care, IPA operations, health plan operations, or a related field
• Experience owning or contributing meaningfully to client facing operational work, with demonstrated accountability for outcomes
• Demonstrated verbal and written communication skills, including the ability to listen actively, run structured client meetings, and communicate clearly with clients, health plan partners, and cross-functional teams
• Strong organizational skills and the ability to track multiple workstreams, deadlines, and deliverables across a client portfolio
• Strong analytical and problem solving skills, with the ability to work through operational issues across multiple functions and stakeholders
• Ability to manage a portfolio of clients and competing priorities independently in a fast paced environment
• Proficiency in Microsoft 365 (Excel, Word, PowerPoint, Outlook, Teams) and ability to learn multiple systems
• Driver's license

Nice to Haves

• Bachelor's degree
• Direct experience with delegated services (UM, Claims, Credentialing, Eligibility, PHM, Quality, or CX) in an IPA, health plan, or delegated entity setting
• Familiarity with value based care contracts (shared savings, full risk, capitation) and PMPM based service arrangements
• Experience with SLA tracking, contract compliance reporting, and health plan or NCQA/URAC audit preparation
• Familiarity with claims workflows, eligibility files (834), capitation reconciliation, and payer portals
• Experience presenting operational and executive level reporting to client leadership
• Basic knowledge of EMR systems and healthcare data platforms

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan includes a 3% employer match to your 6% contribution.
• Life and Disability insurance.
• Voluntary Life options.
• Employee Assistance Program (EAP).
• Paid time off plans.
• Paid parental leave.
• Various resources dedicated to learning and development to advance your career with us.
• All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package.
• Guidehealth provides new employees with the necessary equipment to function in their role at no charge to the employee.