Account Executive

About the role

This remote, field-based position requires regular travel throughout assigned regions in South Carolina. The Account Executive develops strong relationships with providers to drive performance, focusing on core providers in fee-for-service programs, including PCPs, OB/GYNs, high-volume specialists, and FQHCs. Valid driver’s license, current automobile insurance, and reliable personal transportation are required.

Responsibilities

• Supports network development and network management strategies.
• Assists the Leader with departmental activities related to provider satisfaction, education, and communication.
• Contributes to SCA Strategy.
• Builds, nurtures, and maintains positive working relationships between the Plan and its contracted providers.
• Resolves provider disputes in a timely and compliant manner.
• Services assigned provider accounts, which may include single or multiple practices, integrated delivery systems, or other provider organizations.
• Uses data to develop and implement methods to improve relationships.
• Performs site visits as needed.
• Maintains a functional working knowledge of Facets, including the provider database, and routinely relays information about additions, deletions, or corrections.
• Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.
• Demonstrates general operational knowledge related to provider satisfaction, education, and communication, with a fundamental understanding of claims, payment integrity, provider data, credentialing, and appeals disputes.
• Maintains an in-depth understanding of the Plan’s contracts and provider performance and needs, identifying and conducting relevant and tailored provider orientation sessions, educational visits, and issue resolution.
• Assists with recruiting providers based on identified network adequacy gaps (high complexity).
• Supports contracting for multiple product lines, including LTSS, Exchange, and DSNP; may complete straightforward FFS contracts.
• Supports value-based care (VBC) relationships and negotiations where needed.

Requirements

• High school diploma or GED required; bachelor’s degree preferred.
• Equivalent combination of education and relevant experience will be considered.
• Minimum of 1-3 years of Provider Services experience working directly with healthcare providers.
• Demonstrated experience delivering provider education, training, onboarding, and presentations to large groups.
• Minimum of 3-5 years of experience in the managed care, health insurance, or healthcare industry.
• Knowledge of and experience supporting Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs preferred.

Skills

• Experience building and maintaining effective provider relationships.
• Strong presentation, facilitation, and public speaking skills.
• Ability to educate providers on policies, procedures, regulatory requirements, and operational processes.
• Excellent communication, organizational, and customer service skills.
• Proficiency with Microsoft Office applications and provider-facing systems preferred.

Benefits

• Flexible work solutions, including remote options and hybrid schedules.
• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for you and your dependents starting Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.