Under general direction, the Senior Manager, Account Executive supports the management of the Plan partnership between NASCO and an assigned Plan. This role is responsible for championing and supporting Plan strategy to NASCO’s strategy and vice versa. This role assists in aligning the Plan’s strategy to NASCO’s strategy in order to foster a beneficial relationship and provide the best customer service possible. The Account Executive identifies areas for overall growth and performs activities to improve customer satisfaction of the Plan he/she supports. General responsibilities include forming a customer relationship strategy, supporting business development initiatives, and managing resources at the Plan. Additionally, this role is expected to establish and maintain strategic relationships within the assigned Plan. The Account Executive is viewed as an advocate for the Client within NASCO and as an advocate for NASCO at the Client Site. This position communicates directly with Plan resources at the Director level and below. This role also communicates internally across NASCO within Account Executive and with other departments such as NDT, Operations, Professional Services, Product, Finance, Legal, and Senior Leadership.

Implementations lead for Local Systems for the migration of accounts from CareFirst Blue Cross & Blue, as well as Blue Cross & Blue Shield of Michigan local systems. Provided additional support roles by assisting Horizon Blue Cross & Blue Shield with the implementation of Medigap. Responsible for gathering detailed requirements and closing any system gaps that may result in system enhancement to the NPS Claims, Blue Base and or MembersEdge enrollment and billing system. Serve as a subject matter expert, by providing system overviews for existing and potential Blue Cross and Blue Shield clients. Worked closely with NASCO vendors (IBM, EDS, etc) to ensure system enhancements are met on time and within the budget guidelines.Monitored Customer System Request (CSR’s), and provide the customer with estimates on enhancements.Managed 5+ million dollars in enhancements to the MembersEdge enrollment and billing system on behalf of BCBS of Michigan.Provided subject matter expertise for the implementation such as the Electronic Bill Presentment and Payment system, as well as perform SIT and UAT testingCreated CSR’s and managed CSR on behalf of BCBS of Michigan (MOS) program, ensuring that proper sign-off of requirements, while securing Plan and NASCO funding.Scheduled Technical Detail Design (TDD) review with the client after Analysis & Design is completed by IBM to ensure proper construction system functionality will be delivered.

Managed small to medium size projects, such as the annual Medicare Rate modification, Medco file transmit, and HIPAA mandates. Held JAD Sessions to ensure the proper requirements of the customer were captured and executed into the Customer System Request (CSR) for consulting and or enhancement efforts.Reviewed and tested software/system replacements, such as the MembersEdge application.Researched system specification to determine the feasibility of a project and its life cycle. Worked closely with BCBS of Michigan on the stabilization of the FEP Implementation Worked with 8 Blue Cross and Blue Shield Plans to document their existing and future system state enrollment and billing processes to streamline improvement opportunities to MTM.Provided consulting work to multiple Plans to improve their claims first pass rate by documenting processes and procedures efficiencies.

Answered and responded to incoming calls from Blue Cross and Blue Shield Plans reporting system outage, slow response time, system defects, and batch job failures.Researched system specification to resolve claims and membership system defects. Worked closely with vendors EDS and IBM to resolve Level I and II Manage Now call tickets in a timely and accurate manner.

Responsibilities included managing 14 major accounts effectively to ensure an annual renewal of their business with BCBSF. Managed two Field Service Representative (FSR) for existing and new sale opportunitiesWorked closely with the Sales Representatives by reviewing proposed healthcare product being sold to ensure that the benefits could be properly processed within the system structure and integrity. Conducted monthly site visits to each account to review new mandates, as well as review the claims and billing revenue.Delivered annual renewals to the account, as well as conducted open enrollment sessions with the accounts employees to ensure the understood any changes or new benefits being offered at renewal. Managed the Tropicana onsite Service Representative to ensure enrollment and claims issues were resolved in a timely and accurate manner. Provided underwriting with claims historical data for cost models for potential new business.

Performed benefit coding, setup new group enrollment, processed renewals/rate changes for over 200+ groups. Applied and reconciled over $5 million dollars in premium payments for Small Groups, Large Groups, as well as Individual Direct Pay business. Coded a variety of lines of business “Small Group, Major Account and ASO” for products such as HMO, PPO, POS, Dental additional ancillary products.Enrolled/Maintained Group enrollment for new and renewal business, while associating the rates and the benefits to the group. Converted over 150,000 groups in a timely and accurate manner

Served as a Personal Service Representative maintaining Major groups, while reconciling the enrollment, as well as incoming receivables totaling $1+ millions dollars Served as first level Team lead supervising 30 associates, completing quality review, monitoring productivity, training needs for new associates and current associates. Performed annual reviews, and performance development Plans.Processed Individual Direct Pay enrollment, while reconciling incoming revenue within a timely and accurate manner.