Manager - Payment Integrity Operations

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="https://www.bcbsm.com/" 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="http://www.bcbsm.com/index/about-us/our-company.html" 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="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Full-Time

Competitive Total Compensation Package

Overview: Responsible for planning, organizing, and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures, and business unit goals to make decisions and solve problems.<br /><br /> <p><strong>Departmental Summary:</strong></p> <p>The person in this role owns the end-to-end Enterprise-level Payment Integrity (PI) financial value reporting and performance management functions. As a part of this role, this person is expected to lead cross-functional teams in the planning, design, implementation, and ongoing maintenance of the framework, processes, tools, policies, and data sources that contribute to these emerging and critical Enterprise PI financial functions. Enterprise PI Financial Value Management</p>
Responsibilities: <ul> <li>Manage activities of a department including, but not limited to planning, problem-solving, staff development, and communication.</li> <li>Manage the evaluation of new and existing business processes to identify areas of opportunity and execute business unit objectives, supporting continuous improvement.</li> <li>Lead, direct, evaluate and develop the work of assigned employees.</li> <li>Responsible for special projects, programs, and initiatives to ensure successful delivery of business outcomes.</li> <li>Provide effective and efficient solutions to complex business problems</li> <li>Ensure that day-to-day business unit operations align with organizational objectives.</li> </ul> <ul> <li>Consolidate validated PI financial value data from various sources to enable reporting, trend analysis, benchmarking, and forecasting to support executive-level decisions and to support customer acquisition and retention.</li> <li>Design, develop, automate, and maintain dashboards that demonstrate PI value delivery across multiple dimensions for executives and current and prospective customers.</li> <li>Develop enterprise PI performance management program, including goals and Key Performance Indicators based on performance trends, opportunity analyses, and market-based benchmarks.</li> <li>Oversee and coordinate the ongoing enterprise PI value management processes including financial reporting, financial process compliance, data integrity, and issue and risk management.</li> <li>Performs complex analysis of enterprise PI value from numerous internal and external data sources.</li> <li>Interprets and synthesizes data for consumption at the executive level, to facilitate data-based decision making.</li> <li>Conducts analyses and develops reporting to understand trends, performance to goals and benchmarks, variances, and opportunities for financial and operational improvement.</li> <li>Designs, implements, and provides ongoing oversight of processes required to establish consistently reliable enterprise PI financial value forecasts. Serves as the owner of all methods and tools required to enable the enterprise PI financial value forecast model, and advocates and leads initiatives to improve the forecast model.</li> <li>Responsible for the overall direction, coordination, and evaluation of the assigned team. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in a related field is required.&nbsp; Master's Degree in a related field is preferred.&nbsp;</li> <li>Five (5) years of experience in a related field is required.</li> <li>Previous experience leading projects and/or teams is required.</li> <li>Ability to effectively lead, coach and develop team members.</li> <li>Ability to work effectively in a team environment.</li> <li>Strong organizational, planning, analytical, and problem-solving skills.</li> <li>Working knowledge of corporate organizational structures, including functional responsibilities.</li> <li>Strong verbal, written communication, and interpersonal skills.</li> <li>Ability to manage multiple priorities concurrently.</li> <li>Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.</li> <li>Ability to interface and present to all levels of the organization.&nbsp;&nbsp;</li> <li>Ability to build relationships and work collaboratively with cross-functional teams.</li> </ul> <br /> <p><strong>Departmental Preferences:</strong></p> <ul> <li>Knowledge of healthcare claims processes and procedures; Healthcare or Medicaid claim experience&nbsp;preferred</li> <li>Financial analysis or accounting experience</li> <li>4+ years of production level experience working with data, business intelligence toolsets, preferred</li> <li>2+ years of experience writing SQL used in report customizations (ability to evaluate, modify existing code, troubleshoot when needed, and create new code when there is not an existing code to be manipulated) preferred.</li> <li>Experience with advanced data modeling techniques; predictive modeling, link analysis, graphical analysis, supervised and unsupervised models</li> <li>Experience with Tableau, Python</li> <li>Ability to apply critical thinking and analytical tools to outgoing reports</li> <li>Ability to design and develop complicated reports including sub-reports, graphical reports, and well-formatted reports according to user requirements</li> <li>Exhibit a commitment to data quality by validating results compared with the data warehouse database at each step of the development process</li> <li>Inherently curious and interested in growing their own knowledge set, self-motivated and quick to learn and apply knowledge</li> <li>Ability to champion and manage new initiatives to completion to improve and streamline operations processes and maximize systems efficiency</li> </ul>