Hi, I’m
EDUARDO ROSALES
Gilbert,AZ
Summary
Highly organized and motivated Account Executive with demonstrated track record of building relationships with clients, developing successful sales campaigns, and managing teams of account managers. Skilled in financial analysis, customer service and problem-solving. Experienced in coordinating activities with various departments to achieve strategic objectives.
Overview
15
years of professional experience
1
Certification
Work History
BCBSAZ
Provider Account Executive
09.2023 - Current
Job overview
- Sole point of contact for high profile facilities and groups
- Responsible for coordinating all requests from dedicated group(s) including claims issues, credentialing questions, roster verifications, precert coordination and other duties as assigned
- Establish and maintain positive working relationships with assigned provider group(s)
- Managed multiple accounts simultaneously while maintaining organization and prioritizing tasks efficiently
- Facilitate at least monthly meetings with assigned groups to address concerns, share network updates, provide education, provide updates on corporate initiatives
- Ensured the resolution of provider inquiries and issues, identifying and escalating barriers to leadership for assistance
- Respond timely to provider calls and emails
- Works collaboratively with internal teams to address provider complaints
- Ensure provider complaint tracking is completed and to the customer satisfaction
- Conduct and document provider visits
- Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified
- Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS
- Attend monthly onsite staff meetings and other meetings in person, as required.
ARTHUR J GALLAGHER
Client Service Manager
02.2023 - 09.2023
Job overview
- Supporting the business priorities of Branch Managers, Producers, and of the Client Service Function
- Growing revenue by successfully counseling clients on additional lines of insurance or limit increases that should be considered based on the details of each client's unique exposure to risk
- Delivering high quality client service consistent with AJG operational standards and practices
- Achieving operational efficiency and performance metrics consistently
- Growing and profitably managing an assigned group of client accounts successfully
- Building relationships with existing clients by providing outstanding ongoing customer care
- Seeking referrals from current client base to solicit new business prospects
- Securing existing business and actively driving the sale of additional services and lines of coverage
- Checking quotes including communications with underwriters and producers in relation to observations
- Gathering relevant information from client or other resources to prepare submissions
- Marketing and remarketing business
- Collaborating with underwriters
- Advising service staff on individual account needs.
PREMERA BCBS
NA Account Executive
04.2022 - 09.2022
Job overview
- Renew and retain the business of assigned accounts
- Drive the renewal strategy, activities and programs at key accounts of Premera or subsidiary companies
- Prospect and sell additional products and/or services of Premera Blue Cross and/or its subsidiaries to existing accounts
- Prepare account specific renewal strategy and service plans to renew accounts on a sound financial basis
- Effectively recommend changes in response to renewal action or market demands, and that are consistent with administrative capabilities of the organization
- Collect and analyze relevant data to prepare, implement and monitor annual sales and renewal plan for assigned territory
- Coordinate with internal Departments to resolve problems and provide service
- Provided exceptional customer service, addressing client concerns promptly and effectively to ensure long-term loyalty.
- Educate accounts, business and channel partners regarding account's financial aspects and options for renewing
- Cultivates strong working relationships with assigned accounts, business and channel partners
- Participate in directing and training sales support staff and coordinate with internal departments to assure that appropriate service is provided to assigned accounts
- Conduct employee enrollment meetings and develop appropriate communications strategies
- Review on a monthly/quarterly basis the appropriate data on assigned accounts in order to retain and maximize profitability and growth.
BLUE CROSS BLUE SHIELD
NA Strategic Account Manager
09.2018 - 04.2021
Job overview
- Responsible for sales, service and retention of group health insurance, dental, and vision
- Prospects for new business to meet sales quotas
- Determines business needs, develops and presents product proposals (RFP), follows up on proposals for all lines of business and sells additional lines of business to existing groups
- Maintains existing business in all product lines
- Prepares and presents annual renewal information and provides alternatives, when needed
- Conducts renewal meetings with supporting documentation such as utilization and alternative finance reports detailing group usage and rating
- Provides plan options, rates, information for group discussion and decision making, as needed
- Yearly strategic marketing and communication planning
- Discusses and resolves group questions or concerns about their insurance
- Resolves customer needs and concerns, communicates final outcomes with customers and assists with renewal meeting, as necessary
- Follows underwriting guidelines ensuring adherence to federal, state and corporate rules and regulations related to insurance
- Completes and confirms that appropriate paperwork is completed for each account with proper signatures based on each state's regulations
- Educates group leaders on new or changed legal and underwriting requirements, and participates in carrier-offered education
- Serves as a representative of the Company in community activities to provide a positive image
- Participates in local service organizations and volunteer activities, serves on charitable boards and participates in association meetings, when necessary.
UNITED HEALTHCARE
Account Manager
01.2016 - 08.2018
Job overview
- Primary escalated service contact for SB Employer Groups (51-99 employees) and their respective brokers
- Lead and facilitate direct benefits, education, and wellness meetings
- Accountable for increasing electronic services utilization and training of employer groups for assigned accounts
- Served as the ultimate point of contact for determination and resolution of complex service issues for brokers and customers
- Developed and enhanced stronger working relationships with current employers and their brokers that encourage loyalty with United Healthcare
- Support and increase the profitability of business through sharing value added capabilities to current accounts
- Research, analyze and identify root causes of complex service issues for brokers and customers
- Direct dedicated functional experts (billing, customer service, claims, etc.) on corrective action steps / issue resolution to ensure end to end resolution of the issues
- Lead, direct and conduct enrollment, benefit meetings and health fairs for assigned business
- Consult and education brokers and employers on enrollment, benefits, value-added programs, and electronic service processes
- Support, influence, educate and train employer groups about UHCs online electronic services, tools and technologies
- Directly responsible for 1) Timeliness and quality of support provided to management, customers, and brokers 2) Number and quality of open enrollment and education meetings 3) Number and quality of customer and broker training sessions delivered on e-Services and business impact resulting from that training - Multi-site responsibilities
- Subject matter expert for electronic services, customer benefits and wellness, and internal processes
- Daily promotion and support of service model
- Participates and collaborates on special projects as requested by management.
UNITED HEALTHCARE
Bilingual DSNP Retention Specialist
01.2016 - 12.2016
Job overview
- Outbound Calls contacting Medicaid/Medicare eligible members and doing EOB
- Supported Sales/Marketing with special member events
- Calling members inviting them to special events and changes on their benefits
- Answer any questions they may have regarding their health plan and transferring them to proper department
- Escalating and resolving member's concerns
- Replacing insurance ID cards and assisted in assigning PCP's
- Maintaining a high retention rate and overall member satisfaction
- Document member responses and call outcomes in the auto-dialer, Access Database, or CareOne as appropriate
- Experience with CSP Facets, ISET, GPS, ICUE, and VCC
- Assist in the welcome and onboarding process of new employees.
ARIZONA PRIORITY CARE
Provider Relations Representative
09.2015 - 12.2015
Job overview
- Responsible for managing 42 Providers and 35 Specialists
- Assists with investigating and resolving administrative issues and concerns between AZPC, provider networks and the health plans
- Responsible for 3,400 members
- Managed geographic territory assigned
- Commuted 80% of my time seeing providers educating and training them on Medicare Plans policies and procedures per CMS guidelines
- Acted as a liaison/advocate between the health plan and providers
- Assist with marketing AZPC by attending and participating in employer group events
- Assist in educating PCP's on HCC and STARS Measures while improving RAF score
- Resolved any issues between the PCP and Specialists, which included any patient problems or concerns
- Worked with contracting/credentialing, prior auth, claims, and referral department to make sure that providers were accurate and current
- Responsible for tracking and logging PCP and Specialist visitations on a weekly basis
- Tracked and resolved and provider portal issues
- Assisted and attended marketing events for our Providers and Members.
TANGIBLE TANNING & FITNESS
Owner & Operations Manager
07.2009 - 07.2015
Job overview
- End to End operational management of facility
- Daily Management of a team consisting of 10 employees
- Maintain a clean and safe environment for both employees and clients
- Responsible for new hire recruitment, training and development of employees
- Responsible for P&L reports, marketing efforts, financials, purchasing, and weekly payroll
- Customer retention, complaints, and safety.
AETNA
Customer Service Rep for Mercy Maricopa Integrated Care
01.2013 - 06.2015
Job overview
- Answered inbound calls in a high-volume call center for AHCCCS Behavioral Health Program
- Assisted members in transitioning from the old Magellon AHCCCS program to MMIC
- Explained coverage and benefits to AHCCCS members
- Assisted clinics in verifying coverage and looking up CPT codes while following HIPPA guidelines
- Assisted members in doing PCP changes
- Partnered with pharmacies to troubleshoot and understand why member's prescriptions weren't being processed
- Assisted in requesting single case agreements with other clinics and other AHCCCS territories
- Setup and coordinated transportation for qualifying members.
Education
MESA COMMUNITY COLLEGEMesa, AZ
Associate of Business Administration
05.2008
Skills
- Fluent bilingual in Spanish
- Account Management
- Client Management & Consulting
- Relationship building and management
- Coaching-Counseling-Trainer
- Change & Project Management
- Healthcare Solutions experience
- Adaptable and flexible
- Strong Implementation skills
- Confident
- Motivated
- Insightful
Certification
Illinois Life and Health Producer License
Timeline
Provider Account Executive
BCBSAZ
09.2023 - Current
Client Service Manager
ARTHUR J GALLAGHER
02.2023 - 09.2023
NA Account Executive
PREMERA BCBS
04.2022 - 09.2022
NA Strategic Account Manager
BLUE CROSS BLUE SHIELD
09.2018 - 04.2021
Account Manager
UNITED HEALTHCARE
01.2016 - 08.2018
Bilingual DSNP Retention Specialist
UNITED HEALTHCARE
01.2016 - 12.2016
Provider Relations Representative
ARIZONA PRIORITY CARE
09.2015 - 12.2015
Customer Service Rep for Mercy Maricopa Integrated Care
AETNA
01.2013 - 06.2015
Owner & Operations Manager
TANGIBLE TANNING & FITNESS
07.2009 - 07.2015
MESA COMMUNITY COLLEGE
Associate of Business Administration
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