Manager - High Cost Claim Management

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.

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Competitive Total Compensation Package

Overview: <p>Responsible for planning, organizing, directing, coaching and leading assigned team members. Operate within broad objectives to ensure optimum utilization of capital, manpower, and equipment for a large account.</p>
Responsibilities: <ul> <li>Managing the activities of the department, including, but not limited to: planning, problem solving, team member development, selection and hiring of staff, customer experience, communication and providing leadership and direction to staff and ensuring that departmental processes and procedures are met.</li> <li>Overseeing and delegating work to ensure that operational standards and servicing specific performance guarantees are met in a fiscally responsible manner while maintaining a continued focused on ensuring that customer experience expectations are being met.</li> <li>Lead and conduct weekly internal and external status meetings.</li> <li>Work closely with the provider audit team to ensure strategic alignment.</li> <li>Provide effective/efficient solutions to complex business problems such as claim issues by applying theory, analytical tools and creativity.</li> <li>Drives the evaluation and resolution of high cost claims with the account, partnered Blue Plans, and internal departments.</li> <li>Managing and delegating assignments and special projects on time and in accordance with expectations.</li> <li>Managing a diverse workforce which includes real time coaching, motivation, and mentoring.</li> <li>Responsible for keeping abreast of all BCBSM's products, programs, administrative policies and procedures.</li> <li>May provide supervision to others.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in Business Administration or related field required. Master's Degree in related field preferred.</li> <li>Five (5) to seven (7) years&rsquo; experience in related field including experience in a leadership role (e.g., customer, staff, etc.). required.</li> <li>Excellent leadership, decision making, analytical, organizational, planning, presentation, problem resolution, sales, verbal and written communication skills.</li> <li>Strong interpersonal skills and ability to effectively interface with management.</li> <li>Extensive knowledge of marketing concepts, management principles and the health insurance industry.</li> <li>Detailed understanding of retention efforts and processes.</li> <li>Strong strategic orientation with ability to develop plans to deliver expected results</li> <li>Proficient in current industry standard PC applications and systems.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>