Project Consultant - MA Grievance and Appeals (Compliance)

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.&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: Accountable for and manages the development, implementation and ongoing maintenance of project(s) with moderate to complex scope and deliverables. Project scope is at least two years planning to implementation and may impact one or more business unit/function. Project scope typically impacts one or more of the following: process, system, function, product and/or service
Responsibilities: <ul> <li>Develop detailed project plans and schedules and identify goals, objectives, risks, and resource allocation.</li> <li>Monitor project status for significant deviations in quality, cost, or schedule. Interface with various departments, senior management, and external individuals providing value and support for continuous improvement.</li> <li>Support development of project budgets and update, as required.</li> <li>Coach and mentor team members.</li> <li>Provide feedback on team performance.</li> <li>Ensure that expectations are developed, controlled, and executed in a timely manner.</li> <li>Represent leadership staff at meetings in their absence.</li> <li>May provide supervision to others.</li> <li>Other duties as assigned.&nbsp;</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field required.</li> <li>Five (5) or more years' experience in related field.</li> <li>Three (3) years project management experience in health plan operations or related field</li> <li>Project Management Professional Certificate preferred.</li> <li>Leadership and/or analytical experience with data, systems, and operations.</li> <li>Knowledge of program management preferred.</li> <li>Excellent analytical, organizational, problem solving, verbal and written communication skills.</li> <li>Knowledge of project management tools and methodologies.</li> <li>Ability to work independently, within a team environment and with multiple priorities.</li> <li>Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).</li> <li>Ability to work closely with the technical support team in understanding and resolving systems issues.</li> <li>Ability to develop, implement, and monitor policies and procedures.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p><strong>Departmental Preferences</strong></p> <ul> <li>Knowledge and understanding of Medicare Parts C&amp;D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance</li> <li>Knowledge of Medicare Managed Care Manuals</li> <li>Knowledge of CMS Audit Protocols</li> <li>Understanding of Medicare audit requirements for Medicare Advantage plans</li> <li>Experience in training and/or OJT</li> <li>Function as a SME for various conference calls and ad hoc sessions&nbsp;</li> <li>Documenting improvement opportunities and providing feedback as necessary&nbsp;</li> <li>Experience in process flow and job aide creation</li> <li>Ability to act a point-of-contact across the department for support and expertise</li> </ul> <p><em>All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</em></p>