Senior Health Care Analyst - URMBT Analytics

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 Compensation and Benefits Package

Overview: Provide URMBT with high-quality analytics, reporting and data management.<br /><br />Responsible for planning, organizing, and implementation, of individual assignments.&nbsp; Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.&nbsp; Investigate, review, recommend, communicate and implement solutions that identify problems/root cause of issues.<br /> <p style="font-weight: 400;"><strong><u>DEPARTMENT PREFERENCES</u></strong></p> <ul style="font-weight: 400;"> <li>Understanding of URMBT benefits and product structures preferred.</li> <li>&nbsp;Experience with self-service reporting systems to aggregate or drill into healthcare claims (e.g. Whyzen, Cognos, Advantage Suite) is a plus.</li> <li>Knowledge of advanced statistical methods for analyzing health care data and data mining is a plus.</li> </ul>
Responsibilities: <ul> <li>Demonstrate comprehensive knowledge of BCBSM business, products, programs, and systems (e.g. claims, membership, provider data, network) and corporate organizational structure and functional responsibilities.</li> <li>Complete root cause analyses and impact assessments on the account and corporate issues. Identify and document recommendations/solutions for account and customer.</li> <li>Identify the impact of corporate projects on customer's external data warehouse and analytics. Act as liaison between corporate business areas, account team, and customer. Communicate details to account and customer.</li> <li>Triage customer inquiries regarding claims processing and supporting data. Identify and address gaps in data quality.</li> <li>Track customer data inbound and outbound activities to ensure compliance with standards and contract requirements. Work with customers and vendors to ensure appropriate reporting of Blue data.</li> <li>Provide expertise and guidance to the unit and corporate staff as required.</li> <li>Interpret account data (utilization, cost, program) to provide insights.</li> <li>Other duties may be assigned.</li> </ul>
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 of experience in a related field, typically in two (2) subject areas (e.g. claims adjudication, data quality, and management, customer account servicing, financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis).</li> <li>Excellent analytical, planning, problem-solving, verbal and written skills to communicate complex ideas.</li> <li>Ability to work independently demonstrating excellent organization and time management skills with the ability to manage multiple/differing types of tasks.</li> <li>Ability to coordinate projects and participants outside the immediate team and account.</li> <li>Ability to develop and provide clear and simple communications (verbal and written) to customers, vendors, and employees at all levels.</li> <li>Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li> <li>Comprehensive knowledge of data warehousing, data analysis, and Business Intelligence / Data Mining tools. Experience with retrieving data from large relational databases and large datasets.</li> <li>Strong knowledge of Commercial, HMO, and Medicare claims data.</li> <li>Other related skills and/or abilities may be required to perform this job.&nbsp;</li> </ul>