Account Manager IV

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us.

We pride ourselves on our best‑in‑class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

This position is responsible for retaining existing accounts and selling additional product lines, where appropriate and profitable, within the Labor market segment. The Account Manager for the Labor market serves as the primary relationship manager for assigned labor union health and welfare funds and gaming accounts. This role is responsible for account retention, operational excellence, and strategic support across complex, self‑funded and fully insured labor groups.

The Account Manager acts as a trusted advisor to fund trustees, administrators, TPAs, and consultants while coordinating across internal Horizon teams to ensure service delivery, compliance, and performance expectations are met. Labor accounts have unique governance, regulatory, and service requirements, requiring an elevated level of expertise, responsiveness, and relationship management.

• Manage contract renewals, including negotiating terms and approving contract modifications outside standard guidelines to support retention and growth.
• Assess client needs and recommend appropriate products, including identifying opportunities to sell additional lines of business.
• Develop and maintain trusted relationships across Labor stakeholders.
• Serve as the day‑to‑day account lead, maintaining consultative relationships with administrators, TPAs, brokers, and consultants.
• Monitor service performance, contractual obligations, and performance guarantees where applicable.
• Support renewal strategy, including plan design changes, pricing discussions (in partnership with Sales), and benefit modifications.
• Represent Horizon at trustee meetings, board meetings, and client‑requested forums.
• Proactively manage client expectations and escalate issues as appropriate to ensure timely resolution.
• Partner with Data & Reporting teams to deliver client‑specific reporting and performance insights.
• Coordinate internally with Service, Claims, Provider Contracting, Network, Finance, Compliance, IT, and Vendor partners to resolve complex issues.
• Lead discussions related to claims, eligibility, billing, stop‑loss coordination, provider network issues, and escalations.
• Analyze relevant factors and outcomes to make binding financial, operational, and service‑related decisions.
• Focus on managing account performance, forecast and financial outcomes.
• Perform additional duties as assigned by management.

• High School Diploma or GED required. Bachelor’s degree preferred, or equivalent relevant experience in lieu of a degree.
• Minimum of ten (10) years of account management experience with increasing responsibility, including strategic client relationship management, contract negotiation, and renewal optimization, preferably within the health insurance industry.
• Sales and/or Account Management experience within Labor and Public Sector markets strongly preferred.
• Experience with ASO groups both Full Administration and Shared Administration preferred.
• Requires a New Jersey State Health/Life License.
• Advanced proficiency in personal computers and Windows‑based software, including Microsoft Word, Excel, and PowerPoint; familiarity with intranet and internet applications.
• Knowledge of union structures, Shared Administration/TPA models, and collective bargaining agreements.
• Understanding of group health product lines, including Managed Care.
• Knowledge of rating processes and policy renewal practices.
• Preferred knowledge of Horizon BCBSNJ products, underwriting policies, enrollment, billing, and claims processing…