Fallon Health

  • Account Executive Health Insurance ( TPA) - Fastest Growing Health Insurance Company

    Location US-MA-Pembroke
    Posted Date 3 months ago(3/29/2018 10:59 AM)
    Job ID
    # Positions
  • Overview

    About Fallon Health:


    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.


    About Group Insurance Serive Center ( GISC):

    Headquartered in Pembroke, MA, GISC is a Fallon Health Company that manages health care benefits in numerous states including Massachusetts, New Hampshire, New York, Pennsylvania, Rhode Island and Vermont. GISC is a third party administrator (TPA) that specializes in the administration of self-funded employee health, dental and short-term disability plans.


    Group Insurance Service Center, Inc. A fallon Health Company,  was re-established in 1995, but its' roots go back to 1972, as a professional third party employee benefit administrator. GISC has been a third party administrator since 1972. We believe our longevity is in part due to dedicated employees who have been here from the beginning. They bring a sense of family and commitment to our company and that comes through to our clients and their employees. They are knowledgeable about many aspects of our organization from claims to accounting to underwriting. We work as a team, are flexible and pool our resources to meet your changing needs.



    GISC specializes in the administration of employee health, dental, life, AD&D, and short-term disability insurance and is an approved claim payment facility for major A+ insurance carriers. Our management personnel are members of both local and national industry associations and stay up-to-date with the rapid changes in benefits, government regulations, employee expectations and recruitment demands. We maintain memberships on important committees of the Society of Professional Benefit Administrators and local Chambers of Commerce and will keep our clients up to date with government and industry developments.



    We are looking for a motivated, experienced TPA Account Executive individual with a successful track record who will be responsible for our growing clientele, The candidate who takes on this role will have solid Account Executive experience working in the Health Insurance, but also top notch communication skills and the ability to present in fornt of large groups. As well as the ability to  and communicate directly to professionals in a variety of companies/industries.


    The responsibilities of this position are:


    Strategic Customer Management

    • Provide consultative support for Plan, include plan Design Options
    • Keep customer apprised of market changes/legislative changes
    • Respond to customer / plan needs
    • Troubleshoot plan issues – claims, administration, etc.

    Plan Performance Review

    • Prepare utilization reports and analysis for regular customer plan review meetings (approx. quarterly)
    • Conducting plan review meetings – typically face to face meetings
    • Respond and prepare ad hoc analysis as needed.

    Manage Renewal Process 

    • Stop Loss Marketing
    • Conduct stop loss marketing for each medical customer’s renewa
    • Negotiate renewal rates with carrier
    • Prepare customer renewals
    • Prepare cost illustration with renewal rates and alternative stop loss options

     Placement of renewal and notification to service vendors of any Plan changes or vendor changes.   Notifications to:

    • Stop loss carrier (completion of stop loss application)
    • Communication of Changes to Internal Staff
    • New rates and factors for billing
    • Plan changes to plan build team and claims admin team
    • Vendor changes (if any) 

    Material Updates

    • Plan Summaries
    • SBCs
    • Plan Documents
    • Admin Agreement – Schedule A
    • ID Card updates 


    Open Enrollment Meeting support

    • Develop plan communication materials
    • Conduct/support customer open enrollment meetings




    Additional Requirements:


    • Bachelor’s Degree
    • Travel – typically day trips, but occasionally overnight (based on location of meetings      and reps personal travel preferences) . Little to no air travel
    • Some broker/client entertainment
    • Broker/Producer license for Accident and Health products (can be added at later date)
    • Excellent presentation skills.
    • Ability to travel throughout the Northeast
    • Solid working knowledge of Microsoft Office products (Word, Excel, PowerPoint).
    • Strong self-management and self-motivational skills



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