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Manager

• Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents
• Serve as a liaison between departments, vendors and clients to ensure collaborative progress
• Exhibit strong working knowledge of customer business operations
• Demonstrate strategic business acumen in decisions affecting bottom line focus
• Generate and deliver accurate and timely reports
• Assist with troubleshooting for technical issues
• Serve as a role model in demonstrating core values of customer service
• Encourage continuous learning, personal development and accountability through team members
• Provide timely and thorough responses to internal and external customers
• Respond to member and group correspondences regarding plan/guideline or claim questions within 24 hours
• Escalate difficult issues to the appropriate channels
• Assist in the processing and resolution of escalated issues
• Ensure team compliance with service standards
• Follow trends within assigned scope and alert appropriate parties of any trends that fall outside quality parameters
• Develop and execute plans to meet established goals
• Provide continuous feedback to strengthen and optimize quality performance
• Work cross-departmentally to improve or streamline procedures
• Maintain up to date knowledge on industry trends and look for new data sources
• Develop new and improve current internal processes to improve overall quality
• Conduct regular performance evaluations of employees and provide ongoing feedback and coaching as necessary
• Address and counsel employees on behavioral or performance problems and implement corrective action as necessary
• Explain and administer company policies required for team members to perform duties successfully
• Distribute and monitor departmental workloads to ensure adequate coverage while meeting quality and service levels
• Oversee new and ongoing training and update training manuals
• Coordinate and actively participate in departmental meetings

Claims Manager

Account Manager

• Lead pre- and post-sale presentations and coordinate regular client meetings to maintain strong relationships and ensure alignment on goals and services.
• Drive revenue growth through upselling, cross-selling, and strategic account planning across assigned clients.
• Manage and track client communications using the CRM system
• Oversee client proposals, renewals, and implementations, ensuring timely and effective execution in collaboration with internal teams.
• Develop and maintain Strategic Account Plans that outline client goals, key initiatives, and growth opportunities.
• Serve as the primary client contact, ensuring timely communication, issue resolution, and overall satisfaction.
• Demonstrate strong knowledge of AMPS products and services, effectively aligning solutions with client needs.
• Collaborate with internal teams to resolve client issues, improve service delivery, and streamline processes.
• Ensure compliance with company policies, procedures, and HIPAA standards in all client interactions.
• Partner with Operations, SMEs, and other departments to meet client requirements and strengthen relationships.

Attorney

• Supports the Legal Department by managing claim negotiations, appeals, and related legal documentation.
• Plays a critical part in resolving claims efficiently and ensuring compliance with applicable plan provisions, contracts, and regulations.
• Serves as a key liaison between internal teams and external stakeholders, utilizing strong negotiation, communication, and analytical skills to achieve timely and effective resolutions.
• Review claim information, supporting documentation, and system data to evaluate appropriate settlement strategies.
• Prepare, present, and negotiate settlement offers with clients, providers, and third-party collection entities.
• Manage appeals through resolution, ensuring adherence to internal procedures and applicable regulations.
• Exercise strong judgment when resolving complex or escalated claims and identify matters requiring further legal review.
• Maintain accurate, thorough, and timely documentation of negotiations, communications, and outcomes within internal systems.
• Utilize system functionality to track claim status, deadlines, and resolution metrics.
• Communicate professionally and effectively with internal departments and external stakeholders regarding claim status, settlement offers, and resolution timelines.
• Provide timely follow-ups and clear explanations to ensure transparency and manage expectations throughout the negotiation process.
• Ensure negotiation strategies and resolutions align with contractual obligations, and applicable laws and regulations.
• Identify trends, recurring issues, or potential risks related to claims and escalate concerns to Legal leadership as appropriate.
• Collaborate with Legal, Operations, Client Services, and other internal teams to support efficient workflows and positive client outcomes.
• Contribute to the development and refinement of templates, procedures, and best practices related to claims negotiations and appeal resolution.

Legal Negotiator

Customer Support

• Manage daily workload of assigned outgoing provider billing calls
• Promptly answer incoming Recovery Line calls
• Monitor and respond to voicemails in a timely manner
• Research and update provider records in Recovery internal systems
• Maintain HIPAA compliance and request medical records as needed
• Ensure urgent calls are managed with priority
• Additional miscellaneous duties as assigned by supervisor

Recovery Support Specialist

• Provide client facing support, internal and external reporting, submit client access requests, and assist with benefit set up and project support as requested
• Maintain ownership for assigned service/operational deliverables and ensures operational excellence
• Assist with monitoring and identifying service trends as requested, to allow for immediate resolution of any service issues
• Assist with both standard and non-standard reporting/analytics as needed
• Handle Billing and Rebates research
• Collaborate and take immediate action to resolve operational/service-related issues; escalate issues when appropriate and drive recovery efforts
• Serve as the voice of the client within Drexi to drive continuous service improvement and accountability
• Coordinates deliverables with internal operational departments to ensure client satisfaction and loyalty
• Attends Open Enrollment events

Claims Manager

Account Manager

Legal Negotiator

Recovery Support Specialist

Associate Account Manager