I'm responsible for the retention of existing membership and the pursuit of new business within in the medium to large business segment. . My role is responsible for the day-to-day relationships within our book of business. In my role, I'm responsible for identifying opportunities for membership growth and retention. If there are any escalated issues or a need for special initiatives, I'm the point person for BSC. Create unique value propositions during open enrollment / client meetings and develops creative solutions based on known and anticipated client needsStrategically utilize understanding of market trends to strengthen the BSC value proposition, linking and aligning market insights to customer priorities (have relationships and prospective outside of BSC resources)Facilitate and lead open enrollment / admin / health fair meetings while anticipating client and member questions and providing in-depth responsesActively participate in finalist presentations. (CALPERS: Facilitates open enrollment / client / health fair meetings. Anticipates client questions and can provide in-depth responses)Build relationships with key clients, understand their priorities, and build a trusted advisor relationshipAppropriately leverage available resources to complete back-office tasks and solve problems Work effectively in a team setting but also be able to work independently to complete projects and tasksEffectively create and execute strategies to develop overall client and broker relationships Proactively collect market feedback for internal process and operations improvementAct as the point person for escalated membership needs

Responsible for successfully onboarding ASO, Premier, large group, and high complex clients. Manage implementations for new and existing client relationships and ensuring client goals and expectations are met or exceeded. At the same time, successfully manage multiple highly complex client implementations and renewals that require a high degree of customization. Cultivate strong internal and external partnerships across all functional levels. Accountable for leading and developing standard and customized implementation processes that enable positive client outcomes. Engage with clients to identify, understand, and translate complex business requirements. Lead implementation strategy and timeline development with clients, brokers, third party administrators and internal enterprise teams through virtual and in person meetings to successfully deliver custom implementations. Implement a mitigation/action plans to lead and drive improved outcomes. Responsible for the success of implementation by providing guidance, coaching, training, SME level knowledge to achieve improved and consistent results of self and team. In partnership with sales, develop and deliver customer finalist presentations to win new business.My scope of work includes BAU and RFP proposals. I supported work on BAU for specialized areas and managed RFP’s & proposals. Specialized areas include project management, content database management, content editing, and acting as point-of-contact for specific subject areas.

• Assessed market trends, competitive landscape, and customer needs to identify new product opportunities or eliminate product gaps• Partnered with our internal Mandates SMEs to align all • Participated as SME in Sales strategy calls, as a key contributor to the development of plan strategies.• Acted as product subject matter expert, working in conjunction with Sales and Account Management with key customers• Performed market research for use in product development and to ensure competitive advantage on existing products• Resolved complex product design, pricing, and Implementation issues• Developed complex product guides for internal audiences detailing entire scope of operations • Develop internal and external/competitive market assessments and conduct membership/financial analyses to support strategy recommendations • Worked in conjunction with Product Development partners on hand-offs and deliverables for Market Launch • Primarily based in the Core Product area however, supported Small Business & Individual & Families

• Benefit Process and Data Governance• Establish, communicate, and train people, process, tools to manage Benefit Intent & Configuration• Provide strategy to house benefit / feature intent and business rules in PlanDocs for ongoing management• Implement the Product Development methodology by developing the user interface and business rules to enable benefit intent governance. • Define benefit and Product features intent to enable structure data definition for use in governance and Product Design• Aid with Procedure and Diagnostic Coding with our business partners in Medical Policy• Support FACETS model• Collaborate with Mandates teams to integrate Benefit Intent• SME for all Lines of Business with respect to Product work• Support Government Affairs with Benefit Intent related CHBRP Surveys

• Audit Delegated Medical Groups, IPAs, and Hospitals to ensure compliance with State and Federal Regulations for claims adjudication and Appeal/Grievance procedures.• Acted as subject matter expert for delegated entities• Researched new and existing legislation• Communicated findings through verbal and written correspondence to Director level within our contracted Medical Groups• Recommended and monitored corrective actions to ensure entities achieved and maintained compliance standards• Responsible for auditing Medicare claims for payment, coding, and financial accuracy • Tracking of financial and statistical error trends for Claims Examiners primary duties and responsibilities include review of UB04 and CMS-1500 claims, benefit structures and reimbursement, adjudication accuracy of high dollar claims, and reporting statistics for team goals and objectives• Provided training of claims staff on related claims processing and Procedures on a regular basis