Account Manager Executive

UROBERT BUSH

**** ******* **. *******, ** ***** 248-***-**** *********@*****.***

PROFESSIONAL SUMMARY

Well versed professional with 10+ years’ experience within the insurance and network provider space. Confident in ability to communicate with all levels of employees, while creating a healthy workplace environment. Committed to continuous improvement and team success. KEY SKILLS

Strong Communication Negotiation Problem Solving Microsoft Office CAREER HIGHLIGHTS

● Demonstrated expertise in managing large-scale hospital networks and multi-specialty provider groups, ensuring alignment with corporate goals and compliance with industry standards.

● Delivered impactful training and updates to clients and providers on policy changes, operational procedures, and new initiatives, promoting informed decision-making

● Partnered with internal teams to optimize the execution of provider contracts, streamline processes, and enhance service delivery

PROFESSIONAL EXPERIENCE

Blue Cross Complete of Michigan 2019 - 2024

Account Executive / Provider Network Mgmt.

● Responsible for managing and expanding client relationships.

● Served as the primary liaison between the organization and assigned clients, addressing inquiries, resolving issues, and ensuring client satisfaction.

● Established and leveraged internal partnerships to enhance the execution of provider contracts, improve beneficiary satisfaction, and ensure accurate reimbursement for patient care services. Molina Healthcare Inc. 2006 - 2019

Account Manager / Provider Service Representative

● Served as the primary point of contact for over 3,000 physicians, including specialists, primary care providers, and multi-specialty groups, managing contracting, resolving claims issues, and providing timely updates to ensure exceptional client satisfaction.

● Facilitated Joint Operating Committee (JOC) meetings to review and discuss financial performance and HEDIS outcomes.

● Participated in Peer-to-Peer review meetings with Molina physicians and hospital staff to address performance metrics and key issues.

● Successfully resolved outstanding claim issues totaling $2.6 million, addressing concerns related to benefits, authorizations, and system discrepancies.

● Oversaw account projects focused on delivering comprehensive support to providers across all aspects of service.

● Conducted internal audits for provider network development in support of new business initiatives and managed gap coverage issues.

National City Bank 2004 – 2006

Consumer Banker

● Served as point of contact for opening accounts and submitting applications for loans.

● Operated as a resolution specialist when it came to issue with personal and business checking and savings accounts.

● Work Perks specialist in the surrounding community establishing relationships and partnering with the local businesses to create effective advantages to opening accounts with our bank. OmniCare Health Plan 1997 – 2004

Sales Assistant / /Account Manager

● Served as Assistant to the Sales team for all new groups, getting enrollment set up and getting members on the plan.

● Facilitated the enrollment of new members and answering questions for the existing members.

● Handled renewals and open enrollments.

● Negotiated with existing groups to renew contracts on the annual bases.

● Worked with Large groups and Union Organizations EDUCATION

Murray-Wright High School – High School Diploma

Wayne State University – Studied Marketing

Financial Insurance Services – FIS Accident and Health Insurance Certificate of Completion REFERENCES AVAIABLE UPON REQUEST

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