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.<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 />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: management,teamwork,maintain,support,leadership,claims,analysis,degree,knowledge,experience,skills


Competitive Total Compensation Package

Overview: <span style="font-family: arial; font-size: small;"><strong>Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems,</strong></span><span style="font-size: small;">&nbsp;</span><span style="font-family: arial; font-size: small;"><strong>reporting and new products/programs to improve customer service levels and overall quality.</strong></span>
Responsibilities: <ul> <li>Assist and support in the planning, coordinating, developing and implementing of approved projects which are Divisional and/or Corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls, and performance.</li> <li>Analyze, process and/or expedite operational transactions; this may include timely resolution of problems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.</li> <li>Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.</li> <li>Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters communications and graphics.</li> <li>Assist personnel (both internal and external) by answering questions, supplying information and training.</li> <li>Represent department and division as requested on work groups and special assignments. Develop and maintain an effective working relationship with customers or partners.</li> <li>Other duties may be assigned.</li> </ul> <p><strong>Departmental Information:</strong></p> <p>Responsible for identifying new recovery opportunities and claims payment accuracy issues, and for analyzing root cause and providing strategic solutions for the issues. Works independently as well as in a team to achieve the individual and departmental annual goals.</p> <p><strong>ESSENTIAL DUTIES AND RESPONSIBILITIES</strong>&nbsp;include the following. Other duties may be assigned.</p> <ul> <li>Solve problems by identifying errors and overpayments in the claim&rsquo;s system.</li> <li>Uses creativity to help generate new ideas for claim concepts and recovery opportunities.</li> <li>Learn and use multiple computer software, systems and technology.</li> <li>Proficiency and understanding of high value care data, metrics, measures and statistical methodologies.</li> <li>Deliver data-driven recommendations by applying sound analytics.</li> <li>Interprets how claim edits are related to policy statements.</li> <li>Conducts research to explore potential opportunities to expand the current medical policy set.</li> <li>Establish credibility and strong working relationship with 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>Two (2) to five (5) years&rsquo; experience in related field is required.</li> <li>Demonstrated knowledge/competency in the following areas: claims or inquiry processing experience preferred, analytical experience, ability to produce statistical information from conceptual needs, and working with PC application and/or mainframe systems preferred.</li> <li>Effective verbal and written communication skills.</li> <li>Ability to lead and contribute to process improvement programs.</li> <li>Excellent interpersonal skills necessary to interact with all levels of all personnel.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p><strong>SKILLS AND ABILITIES</strong></p> <ul> <li>Excellent analytical, decision making, organizational, planning, creative problem solving, and verbal and written communication/presentation skills.</li> <li>Understands the basic tenets of health insurance, the managed care model,&nbsp;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<strong>.</strong></li> <li>Ability to appropriately summarize and effectively communicate complex concepts &amp; varied data sets to inform stakeholders, gain approval, or prompt actions; Applies to multiple audiences ranging from the analyst to executive level.</li> <li>Competency in oral and written communications particularly in the area of conflict resolution. Ability to identify, define and explain coding errors&nbsp;identified through audit.</li> <li>Ability to manage multiple&nbsp;tasks, prioritize and meet deadlines.</li> <li>Ability to solve complex problems in an ambiguous, unstructured environment.</li> <li>Possess a high degree of creativity and the ability to work independently as well as in a team.</li> <li>Proficient in current industry standard PC applications and systems. Computer proficiency in Microsoft Office (Word, Excel, Outlook) and Access preferred.</li> <li>Extensive knowledge of health insurance, claims adjudication process and payment integrity systems and methods.</li> <li>Understands claims data, how data is stored in analytical platforms, and how to use and apply claims data in the validation of payment accuracy concepts and other projects.</li> <li>Knowledge of BCBSM and/or Blue Cross Blue Shield Association guidelines and regulation knowledge preferred.</li> <li>Self-motivated and driven to succeed.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>