Sr. UAW Retiree Account Rep (URMBT)

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI (Hybrid)

Blue Cross Blue Shield of Michigan

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keywords: position summary,department summary,management,training,education,experience,skills,preferred qualifications,license,travel

Non-Manager

Competitive Total Compensation Package

Overview: <strong><strong>Responsible for providing Best in Class services for the Auto/UAW Retiree Medical Benefits Trust a Market Relations (Autos/URMBT).&nbsp; Responsible for implementing decisions and processes impacting quality, service and efficiencies.<br /><br /></strong></strong> <p><strong><u>Department Summary</u></strong></p> <ul> <li>Serve as a subject matter expert for UAW Trust benefits, claims, and member advocacy.</li> <li>Possess NASCO claims processing knowledge and experience.</li> <li>Demonstrate strong understanding of MAPPO, Medicare Advantage, Commercial, HMO, and PPO benefit structures and claim processing differences.</li> <li>Investigate and resolve complex claims issues, benefit processing concerns, and member escalations.</li> <li>Support member meetings and travel team activities, including direct member interactions and issue resolution.</li> <li>Attend and actively participate in internal and external workgroup meetings representing the Trust account.</li> <li>Coordinate, submit, and oversee benefit implementation requests and ensure implementations are accurately configured and tested.</li> <li>Partner with operational, benefit, provider, and claims teams to identify and resolve processing issues.</li> <li>Provide provider support and research related to claim adjudication and benefit inquiries.</li> <li>Monitor implementation outcomes and work with business and technical teams to ensure benefit accuracy.</li> <li>Serve as a liaison between business partners, claims operations, providers, and members to facilitate timely resolution of issues.</li> </ul>
Responsibilities: <ul> <li> <div>Establish and maintain strong business relationships with Autos/URMBT groups in assigned territories.</div> </li> <li> <div>Resolve escalated customer service, membership, eligibility, claims problems and inquiries that require research and interaction with internal and external entities.</div> </li> <li> <div>Participate in customer/marketing events.&nbsp; Recognize marketing opportunities.</div> </li> <li> <div>Research and prepare customer presentations.</div> </li> <li> <div>Interact/educate subscribers, major auto accounts, unions and Partner Plans.</div> </li> <li>Train, develop and guide new staff in multiple and distinct jobs.</li> </ul>
Requirements: <ul> <li> <div>Bachelor's Degree in related field preferred.</div> </li> <li> <div>Five (5) years experience in related field including the areas of medical benefits, policies and products.</div> </li> <li> <div>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&rsquo;s start date or the license expiration date.<br />&nbsp; &nbsp;&nbsp;1. Valid Michigan or related state Accident and Health Insurance License<br />&nbsp; &nbsp;&nbsp;2. Valid and unrestricted driver&rsquo;s license is required.</div> </li> <li> <div>Excellent analytical, organizational, planning and problem-solving skills.</div> </li> <li> <div>Good verbal and written communications skills.</div> </li> <li> <div>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.</div> </li> <li> <div>Ability to work effectively in a team environment.</div> </li> <li> <div>Other related skills and/or abilities may be required to perform this job.</div> </li> <li> <div>Need to be extremely proficient in Microsoft Excel, PowerPoint, and Word.</div> </li> <li> <div>Extensive travel to business locations and potential clients required.</div> </li> <li> <div>Must meet local and/or national sales and marketing sales competencies as required.</div> </li> </ul> <br /> <p><strong>Preferred Qualifications:</strong></p> <ul> <li>Extensive NASCO experience.</li> <li>Claims processing and claims resolution experience.</li> <li>Provider relations or provider servicing experience.</li> <li>Strong knowledge of Medicare Advantage (MAPPO), Commercial, HMO, and PPO products.</li> <li>Experience with benefit implementation, configuration, validation, and testing.</li> <li>Ability to manage member escalations and complex operational issues.</li> </ul>