Claims Process Analyst

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.

Grand Rapids, 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.&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="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 />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. 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: management,provide,teamwork,support,create,assemble,communication,experience,knowledge,degree,analysis,organization,departmental requirements

Full-time

Competitive Compensation and Benefits Package

Overview: 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.
Responsibilities: <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 in special projects or workgroups as assigned.</li> </ul>
Requirements: <ul style="font-weight: 400;"> <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>Departmental requirements:</p> <ul> <li>Two (2) to five (5) years&rsquo; experience in health care environment, preferably in managed care.</li> <li>One (1) year process improvement experience.</li> <li>One (1) year project management experience preferred.</li> <li>Proven experience in problem analysis, data analysis, root cause identification/document and problem resolution activities.</li> <li>Demonstrated, proficient working knowledge and experience with Microsoft Suite (Excel, Access and Visio) as well as required</li> <li>Digital visualization tools (such as Power BI, Tableau) preferred</li> <li>Health care Claims processing experience required</li> <li>Working knowledge of Facets operational system and Macess highly preferred&nbsp;</li> </ul>