Senior Health Care Analyst / Provider Financial Analysis HCV

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="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.<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 />Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: planning,department summary,research,reporting,goals,communication,reporting,risk management,management,maintain,investigate,accounting,analysis,research,degree,knowledge,experience,analysis,professional

Full-time

Competitive Total Compensation Package

Overview: Responsible for planning, organizing, directing, implementation, and leading department assignments. Position operates within broad objectives to ensure optimum utilization of manpower and budget. Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements&nbsp;<br /><br /> <div><span style="font-family: Arial; font-size: small;">Department Summary / Preferences:</span></div> <div><span style="font-family: Arial; font-size: small;">The proposed position will work with PFA leadership on the pathway to risk vendor tool implementation (providing input on reporting needs, report structure, data mapping to appropriate cost categories, stop loss analysis, tool configuration and UAT testing), reporting process development and documentation and ownership of report package generation and distribution for the Commercial PPO and MAPPO risk arrangements.&nbsp;</span></div> <div><span style="font-family: Arial; font-size: small;">The responsibilities of this position will encompass monthly, quarterly and annual reporting, financial settlement determination for all PPO Commercial and MA risk arrangements, documentation and communication of outcomes, drill-down analyses related to cost drivers and emerging trends, analytic support of the Network Performance and Contracting team, as well as upward communication to leadership in the form of formal presentations/dashboard metrics, etc.</span></div>
Responsibilities: <ul> <li>Leads in the research, analysis, identification and evaluation of data from assigned problems to evaluate existing and potential trends and issues.</li> <li>Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.</li> <li>Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.</li> <li>Develop lines of communication to discuss/review results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.</li> <li>Investigate, review, recommend, communicate and implement solutions which identify problems/root cause of issues.</li> <li>Identify and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities.</li> <li>Independently develop and plan, reports, papers and/or other materials in a clear and concise manner.</li> <li>Provide expertise and guidance to unit and corporate staff as required.</li> <li>Acts as liaison between corporate business areas and participates in group or committee discussions.</li> </ul> <div><span style="font-family: Arial; font-size: small;">Responsible for the PPO risk performance reporting function as well as the preparation of supporting schedules/analyses and documentation.</span></div> <div><span style="font-family: Arial; font-size: small;">Reviews monthly/quarterly financial reports to determine the financial position of each Provider Organization and makes recommendations for financial improvement.&nbsp; Provides supporting documentation and research to explain significant outcome variances.</span></div> <div><span style="font-family: Arial; font-size: small;">Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, provider network, provider data and enterprise programs (e.g. care management, clinical editing, site of care initiatives, etc.) corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.</span></div> <div><span style="font-family: Arial; font-size: small;">Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.</span></div> <div><span style="font-family: Arial; font-size: small;">Develop lines of communication to discuss/review results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.</span></div> <div><span style="font-family: Arial; font-size: small;">Investigate, review, recommend, communicate and implement solutions which identify problems/root cause of issues.</span></div> <div><span style="font-family: Arial; font-size: small;">Identify and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities</span></div> <div><span style="font-family: Arial; font-size: small;">&nbsp;</span></div> <div><span style="font-family: Arial; font-size: small;">Bachelor's Degree in Accounting, Finance, Business Administration, Economics, Health Care, Information Systems, Statistics or other related field is required.&nbsp; Master's Degree in related field preferred.</span></div> <br />
Requirements: <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>Six (6) or more years experience in related experience, typically in two (2) subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management). </li><li>Excellent analytical, planning, problem solving, verbal and written skills to communicate complex ideas. </li><li>Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.). </li><li>Strong working knowledge of data languages such as SAS or SQL. </li><li>Ability to work independently, within a team environment and communicate effectively with employees at all levels. </li><li>Other related skills and/or abilities may be required to perform this job. </li></ul>