• This position is responsible for performing account management functions from the medical management perspective; serving as primary contact for marketing major/national and mid-market accounts specific to presentations for existing and prospective clients, medical issues and questions on medical management programs; serving as liaison between marketing and health care management to analyze data and interpret information in preparation for meetings, site visits, and requests for proposals; and recommending program enhancements to health care management operations based on client feedback. • Ability to travel, including overnight stays.

• Responsible for delivering consistent, profitable Blue Cross NC National Group sales • Promoting current group retention and sale of new product lines to existing clients • Building trusted, enduring relationships with complex clients and consultants • Drives higher financial value for current clients by providing market-leading, data backed solutions • Negotiate renewals and cross sell opportunities with high profile, complex clients and consultants • Identify additional growth opportunities in ancillary products based on client’s needs • Analyze client financial and utilization data and industry trends • Develop a trusted advisor relationship with producers • Collaborate with Client Services team to ensure group issues are addressed effectively • Promote goodwill between BCBSNC and the community

• Act as the primary client contact for Waystar solution-specific set-up and design issues during the implementation stage. • Subject Matter Expert assigned to Waystar revenue cycle implementations - ensuring the contracted deliverables are delivered in compliance with contractual terms, aligned with Waystar processes and drives a high level of client satisfaction. • Ability to manage and meet deadlines. • Establishes trusted relationships with the client project team, key influencers/stakeholders and client executive leadership. • Clearly communicates challenges/shortcomings/issues to customers by assessing causes and implications, recommending solutions and costs, and encouraging shared problem solving. • Develops and communicates a clear vision of customer success and regularly reports out on the status to all key stakeholders.

• Investigating and analyzing moderately complex, single-discipline coverage and claims referred to the Special Investigation Unit (SIU) • Conducting detailed investigations, performing background searches, taking recorded statements, interviewing witnesses, and reviewing social media activity • Evaluating whether fraud can be substantiated and supporting litigation when appropriate • Summarizing documents and maintaining accurate claim files with notes, evaluations, and decisions • Addressing moderately complex customer concerns and inquiries • Reviewing investigation findings to determine if fraud denial is warranted • Conducting thorough investigations, including background checks, and scene inspections • Utilizing analytical tools to identify and validate fraud indicators • Managing vendor relationships and monitoring performance • Making informed decisions on claims and pursuing restitution when necessary • Entering claim data into SIU systems and updating files with investigation outcomes • Returning the file to the market claims office for continued handling and settlement when fraud is not substantiated or evidence is insufficient.