Health Care Analyst - Pharmacy Ops – Data Analytics

<strong>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.</strong>

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.

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Competitive Total Compensation Package

Overview: <br />Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management.<br /><br /> <p><strong>Department Summary/Preferences:</strong></p> <ul> <li>3 years in quality assurance and/or data management required.&nbsp;</li> <li>3 years of work experience in analyzing and developing complex logical database designs, logical data models, and relational DBMS design and support and relevant computing environments required.</li> <li>Support transition of existing accumulator (deductibles and OOPM) tools and processes, as well as development of new processes with the new PBM vendor.</li> <li>Manage the ongoing review, reconciliation, and refunding of accumulator overages for individual and group members affected by retro group-wide changes or retrospective benefit modifications</li> <li>Identify and expedite alignment of member accumulators for groups with integrated benefits for compliance and claims processing accuracy. Coordinate adjustments of accumulators for out-of-sync claims or related to copay coupon programs. Collaborate with BCN Claims and IT teams to ensure compliance and ongoing reconciliation of integrated pharmacy and medical accumulators.</li> <li>Support development of ad-hoc query tools to analyze complex out-of-sync claim issues.&nbsp;Ability to research complex data issues and implement solutions.</li> <li>Position supports the triage and root cause analysis for inquiries from Field Services and Customer Service staff so understanding of pharmacy benefits, products, and membership is a plus.</li> <li>Support planning, development, and implementation of process improvements and projects to support BCN commercial pharmacy operations and system initiatives.&nbsp;</li> </ul>
Responsibilities: <br /> <ul> <li>Research, analyze, identify, and evaluate data from assigned problems to evaluate existing and potential trends and issues. Ability to research complex data issues and implement solutions.</li> <li>Possess and maintain a comprehensive understanding and knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.</li> <li>Assist in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.</li> <li>Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.</li> <li>Recommend, communicate, and implement solutions to identified problems/root cause of issues.</li> <li>Provide expertise and guidance to unit and corporate staff as required.</li> <li>Represent and participate in group or committee discussions.</li> </ul>
Requirements: <br /> <ul> <li>Bachelor's Degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or other related field is required. Master's Degree in related field preferred.</li> <li>Four (4) or more years of experience in related field required.</li> <li>Strong communication skills are required to understand, interpret, and communicate ideas.</li> <li>Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li> <li>Working knowledge of data languages such as SAS or SQL.</li> <li>Strong analytical, organizational, planning, and problem-solving skills.</li> <li>Ability to effectively interface with employees at all levels.</li> <li>Understand and apply statistical inference.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>