Analyst - Clinical Program 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.

Southfield, 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: management,teamwork,support,leadership,assist,create,assemble,analysis,solutions,degree,investigate,experience,professional


Competitive Total Compensation Package

Overview: <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, reporting and new products/programs to improve customer service levels and overall quality.</strong>
Responsibilities: <br /> <ul> <li>Support the development, coordination, and implementation of projects to enhance the overall efficiency of operational procedures, methods, controls, and performance.</li> <li>Compile and analyze operational data to identify and resolve business problems.</li> <li>Utilize and maintain available reporting systems. 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 updates on projects and issues.</li> <li>Communicate and recommend policy changes to achieve project objectives. Assist in documenting departmental procedures.</li> <li>Create and present reports and presentations to display operational data and propose business changes.</li> <li>Provide support to both internal departments and external entities by answering questions, supplying information and training.</li> <li>Participate on special projects or workgroups as assigned.</li> </ul>
Requirements: <strong>Qualifications</strong> <ul> <li>Bachelor's Degree in a related field is preferred.</li> <li>Two (2) years of experience in a related field is required.</li> <li>Effective verbal, written communication and interpersonal skills.</li> <li>Ability to work independently or in a team environment and interact with all levels of the organization.</li> <li>Effective analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.</li> <li>Organizational skills and ability to prioritize; must be able to coordinate multiple activities with varying timelines.</li> <li>Proficient in Microsoft Office suites.</li> <li>Ability to develop and maintain effective working relationships.</li> </ul> <p>Department Summary / Preferences:</p> <p>Responsible for supporting the systems utilized by BCN &amp; BCBSM Utilization Management operations. Analyze authorization related issues and provide timely resolution to inquiries.<br />Investigate and resolve data inaccuracies between UM and claims systems. Evaluate possible corrective actions within system including recommending and implement solutions.&nbsp;<br />Maintenance of tracking of audit tools, applicable reports, policies, procedures, and processes. Work with operational and systems teams to coordinate analysis and testing activities.<br />Knowledge of CareAdvance required<br />Facets, NASCO, IKA, MACESS preferred&nbsp;<br />Proven strong ability to problem solve with a sense of urgency based on timelines and due dates.</p>