Team Lead II - Payment Integrity Post Pay Claims Analysis

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: position summary,management,teamwork,administration,quality assurance,performance,develop,skills,analysis,knowledge,education,department requirements,experience


Competitive Total Compensation Package

Overview: Responsible for planning, coordinating and supervising assigned departments(s)/area(s) to ensure an efficient and cost effective area of responsibility in accordance with established corporate and departmental policies and procedures.
Responsibilities: <ul> <li>Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time.</li> <li>Research, (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.</li> <li>Recommend and assist in the acquisition of technology and other tools or equipment and resources to optimize departmental performance and output.</li> <li>Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.</li> <li>Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and resolve issues and inquiries.</li> <li>Administer and adhere to Corporate and departmental policies, practices, and procedures.</li> </ul> <br /> <p><strong>ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:&nbsp;</strong></p> <ul> <li>Supervise day-to-day team performance and work assignments, including planning directing, supervising, evaluating workflow, and contributing to discussions related to hiring, progressive discipline, and terminations.</li> <li>Recommends operational improvements and is responsible for day-to-day application of policies and procedures.</li> <li>Responsible for quality monitoring</li> <li>Provide team support and guidance on all types of claim specific questions (Facility, Professional, BlueCard, Flexlink)</li> <li>Establish credibility and strong working relationship with the team.</li> <li>Achieve excellence by meeting and exceeding team goals and quality measures</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field preferred.</li> <li>A minimum of 90 college credits is required.</li> <li>Five (5) years of BCBSM/BCN and/or related field experience including at least two (2) years of experience</li> <li>in a leadership role.</li> <li>Strong organizational, planning, analytical, and communication skills.</li> <li>Excellent interpersonal skills are necessary to interact with all levels of personnel.</li> <li>Working knowledge of PC application and/or mainframe systems preferred.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <br /> <p><strong>OTHER SKILLS AND ABILITIES</strong></p> <ul> <li>Excellent analytical, decision making, organizational, planning, creative problem solving, and verbal and written communication/presentation skills. Ability to appropriately summarize and effectively communicate to multiple audiences ranging from the analyst to executive level.</li> <li>Has an understanding of the basic tenets of health insurance, claims adjudication process and payment integrity systems and methods, the managed care model, Commercial (Facility and Professional lines of services), Coordination of Benefits, Medicare &amp; Medicaid rules, industry coding/policy standards, the claim adjudication process. Ability to apply this knowledge to the development &amp; evaluation of new initiatives and lead the team strategy toward best practices.</li> <li>Ability to actively and skillfully conceptualize, apply, analyze, synthesize, and/or evaluate information gathered from, or generated by, observation, experience, reflection, reasoning, or communication</li> <li>Ability to manage multiple tasks, prioritize and meet deadlines. Is self-motivated and driven to succeed.</li> <li>Knowledge of BCBSM and/or Blue Cross Blue Shield Association guidelines and regulation knowledge preferred.</li> </ul> <br /> <p><strong>Department&nbsp;Requirements</strong></p> <ul> <li>Masters degree preferred</li> </ul>