Senior Provider Network Account Executive

Role Overview

The Senior Provider Network Account Executive is responsible for developing and maintaining strong relationships with providers to drive performance, particularly among core providers participating in risk‑based or cost‑sharing Value‑Based Contracting (VBC) arrangements, as well as large health system contracts within our Blue Cross Complete of Michigan (MI) network.

• Remote - Associate must be located in the state of Michigan (MI) and must be able to attend in‑house training and monthly meetings.

• Support overall network development and network management strategies.
• Assist departmental leadership with provider satisfaction, education, and communication initiatives.
• Contribute to Single Case Agreement (SCA) strategy.
• Participate in and implement provider network education programs and materials—both internal and provider‑facing—and serve as the trainer, mentor, and support resource for new Account Executives (AEs).
• Lead and support hospital and physician network development and management, including participation in Joint Operating Committees (JOC) for designated provider groups and oversight of required quality review meetings with targeted providers and/or health systems.
• Build, nurture, and maintain strong relationships between the health plan and contracted providers, including highly complex provider entities.
• Resolve provider disputes in a timely and compliant manner.
• Manage a large and complex portfolio that includes multiple practice locations, multi‑specialty practices, hospitals, contracted subcontractors such as Durable Medical Equipment (DME) vendors, vision providers, and ancillary providers.
• Develop, implement, and manage programs and projects that impact high‑dollar and high‑membership provider groups.
• Conduct site visits as needed.
• Oversee and ensure resolution of provider issues managed by other Provider Network support teams.
• Take corrective action as required—up to and including termination—per organizational policies and procedures.
• Operationalize completed contracts of advanced complexity.
• Consult on Value‑Based Contracting (VBC) agreements, facilitate successful performance management (including JOCs, performance review meetings), and support incentive programs tied to performance improvement.
• Manage Value‑Based Contract (VBC) requirements, including monitoring provider performance standards in relation to VBC or State program expectations, coordinating with key stakeholders, and overseeing data‑sharing and reporting needs.
• Maintain general operational knowledge related to provider satisfaction, education, and communication, with a strong understanding of operational areas, including claims, payment integrity, provider data, credentialing, and appeals/disputes.
• Support contracting efforts for multiple product lines, including Long‑Term Services and Supports (LTSS), Health Insurance Marketplace/Exchange plans, and Dual Special Needs Plans (DSNP).
• Assist with recruiting providers to address network adequacy gaps, particularly in high‑complexity specialties or specific geographic areas.
• Support Value‑Based Contracting (VBC) negotiations and serve as the relationship lead; may also serve as lead negotiator.

• Bachelor’s degree required.
• 5 or more years of experience demonstrating strong communication skills, financial acumen, and the ability to engage in difficult conversations.