Senior Account Representative

Blue Cross Blue Shield of Michigan; United States; Hybrid; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Blue Cross Blue Shield of Michigan seeks an experienced benefits/claims professional to act as SME for UAW Trust benefits, claims, and member advocacy. You will investigate complex claims, support provider relations, and coordinate benefit implementations across MAPPO, Commercial, HMO and PPO products.

Role requires up to 50% travel, strong analytical skills, and proficiency in Excel, PowerPoint, and Word. A bachelor’s in a related field is preferred and licenses must be obtained within 90 days.

Qualifikationen

• Bachelor's Degree in related field preferred.
• Five (5) years experience in related field including medical benefits, policies and products.
• Licenses required within 90 days: Michigan or related state Accident and Health Insurance License; valid unrestricted driver's license.
• Excellent analytical, organizational, planning and problem-solving skills.
• Good verbal and written communications skills.
• Good interpersonal skills to interface with subscribers, accounts, unions, and support areas.
• Proficiency in Microsoft Excel, PowerPoint, and Word.
• Extensive travel to business locations and potential clients.

Aufgaben

• Serve as SME for UAW Trust benefits, claims, and member advocacy.
• Investigate and resolve complex claims issues and member escalations.
• Provide provider support and research related to claim adjudication and benefit inquiries.
• Coordinate and oversee benefit implementation requests and testing.
• Partner with operations, provider, and claims teams to resolve processing issues.
• Attend internal/external workgroup meetings representing the Trust account.
• Monitor implementation outcomes and ensure benefit accuracy.

Kenntnisse

NASCO experience

Claims processing

Provider relations

Medicare Advantage knowledge

Member escalations

Ausbildung

Bachelor’s Degree in related field

Tools

Excel

PowerPoint

Word

Jobbeschreibung

Straight from company career pages. Full refund within 30 days if it's not for you.

$49

Location: Detroit, MI, United States; Hybrid

Moderate travel, including nationwide travel, is required (up to 50%)

Department Summary

• Serve as a subject matter expert for UAW Trust benefits, claims, and member advocacy.
• Possess NASCO claims processing knowledge and experience.
• Demonstrate strong understanding of MAPPO, Medicare Advantage, Commercial, HMO, and PPO benefit structures and claim processing differences.
• Investigate and resolve complex claims issues, benefit processing concerns, and member escalations.
• Support member meetings and travel team activities, including direct member interactions and issue resolution.
• Attend and actively participate in internal and external workgroup meetings representing the Trust account.
• Coordinate, submit, and oversee benefit implementation requests and ensure implementations are accurately configured and tested.
• Partner with operational, benefit, provider, and claims teams to identify and resolve processing issues.
• Provide provider support and research related to claim adjudication and benefit inquiries.
• Monitor implementation outcomes and work with business and technical teams to ensure benefit accuracy.
• Serve as a liaison between business partners, claims operations, providers, and members to facilitate timely resolution of issues.

Preferred Qualifications

• Extensive NASCO experience.
• Claims processing and claims resolution experience.
• Provider relations or provider servicing experience.
• Strong knowledge of Medicare Advantage (MAPPO), Commercial, HMO, and PPO products.
• Experience with benefit implementation, configuration, validation, and testing.
• Ability to manage member escalations and complex operational issues.

Responsible for providing Best in Class services for the Auto/UAW Retiree Medical Benefits Trust a Market Relations (Autos/URMBT). Responsible for implementing decisions and processes impacting quality, service and efficiencies.

Establish and maintain strong business relationships with Autos/URMBT groups in assigned territories.

Resolve escalated customer service, membership, eligibility, claims problems and inquiries that require research and interaction with internal and external entities.

Participate in customer/marketing events. Recognize marketing opportunities.

Research and prepare customer presentations.

Interact/educate subscribers, major auto accounts, unions and Partner Plans.

Train, develop and guide new staff in multiple and distinct jobs.

Qualifications

Bachelor's Degree in related field preferred.

Five (5) years experience in related field including the areas of medical benefits, policies and products.

If an employee is selling/negotiating a rate as part of the duties and responsibilities of this job, the following licenses are required within 90 days of the employee’s start date or the license expiration date.
1. Valid Michigan or related state Accident and Health Insurance License
2. Valid and unrestricted driver’s license is required.

Excellent analytical, organizational, planning and problem-solving skills.

Good verbal and written communications skills.

Good interpersonal skills to interface one on one with subscribers, the account, union, internal support areas or outside organizations involved in servicing the account/union.

Ability to work effectively in a team environment.

Other related skills and/or abilities may be required to perform this job.

Need to be extremely proficient in Microsoft Excel, PowerPoint, and Word.

Extensive travel to business locations and potential clients required.

Must meet local and/or national sales and marketing sales competencies as required.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.

Remote roles only