Analyst - Senior

<p>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.</p>

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.&nbsp;

keywords: technical,implementation,teamwork,quality assurance,consulting,compliance,maintain,leadership,document,analysis,support,knowledge,medical,experience,organization,leadership,reporting,pharmaceutical,maintain,implementation,analysis,departmental preferences,departmental responsibilities


Competitive Total Compensation Package

Overview: Responsibility to coordinate the development and implementation of programs and strategies to improve organizational processes and service. Provide technical and analytical support to specific departmental initiatives such as process improvement, ad-hoc reporting, database maintenance, regulatory compliance, data modeling, documentation, proposal development, etc.
Responsibilities: <ul> <li>Develop and improve work flows and business processes within defined areas to improve customer service and&nbsp; improve overall quality and cost efficiency.&nbsp;</li> <li>Identify and/or analyze business problems and devise procedures for solutions.&nbsp;</li> <li>Effectively lead projects, teams or workgroups in order to produce desired results.&nbsp;</li> <li>Document and communicate project concepts, milestones and results.&nbsp;</li> <li>Recommend and assist with implementing existing and new policies and procedures.&nbsp;</li> <li>Assure that corporate compliance is communicated, implemented and monitored on an ongoing basis.&nbsp;</li> <li>Participate in systems testing, develop procedures/controls and provide recommendations for ongoing improvement of the updated process.</li> <li>Assist internal and external entities through inquiry response, supplying information and training. Develop and maintain effective working relationships with related business partners.</li> <li>Other duties as assigned.&nbsp;</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field preferred.</li> <li>Four (4) to seven (7) years experience in related field.</li> <li>Leadership and/or analyst experience required with demonstrated experience in operational analysis, data analysis, and problem resolution type projects and activities.</li> <li>Ability to plan, organize, and control projects.</li> <li>Excellent written and verbal communication skills.</li> <li>Ability to lead and contribute to related projects.</li> <li>Demonstrated knowledge of Microsoft Office Suite Software and related PC or mainframe applications.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <strong>Departmental Responsibilities:</strong><br /> <ul> <li>Coordinates pharmacy and medical claims data transfer between BCN, BCBSM, contracted rebate vendor.</li> <li>Develops, implements, modifies pharmacy reporting tools; prepares standard and ad hoc pharmacy and medical claims reports.</li> <li>Creates, maintains and distributes shared Access databases that reflect current and past pharmacy and medical claims for primary care groups.</li> <li>Extracts, extrapolates, and analyzes pharmacy and medical claims data in order to calculate rebates for payment from pharmaceutical companies.</li> <li>Resolves discrepancies in rebate payments, reconciles and tracks information for more accurate implementation of rebate payments.</li> <li>Using pharmacy claims data and wholesaler purchasing reports, regularly evaluates information for additional contracting opportunities and cost savings.</li> <li>Provides summary or detailed utilization data as requested for contract analysis/ comparisons, financial reports, and cost saving studies as appropriate.</li> <li>Maintains monthly and quarterly utilization statistics (key metric reports) for internal and external reporting purposes.</li> <li>Analyzes pharmaceutical and medical claims data to determine outcomes of established rebate contracts.</li> <li>Maintain claims data records and rebate claims records in compliance with internal and external audit and respond to audit request as required.</li> </ul> <strong>Departmental Preferences:</strong><br /> <ul> <li>Bachelor's Degree preferred. Major in business, health care or IT related field preferred.</li> <li>Four years experience in a health administration setting.</li> <li>At least two years analyst experience required with proven experience in database management, data analysis, reporting, and problem analysis.</li> <li>Broad knowledge of managed care healthcare delivery systems.</li> <li>Knowledge of using database SAS program preferred.</li> <li>Knowledge of pharmacy claim systems and processing preferred.</li> <li>Knowledge of medical claim systems and processing preferred.</li> <li>Intermediate knowledge Microsoft Office suite (Word, Excel, Access and PowerPoint) required. Knowledge of SQL preferred.</li> <li>Strong organizational skills and follow-through abilities with particular attention to detail required.</li> <li>Ability to develop creative solutions to business issues required.</li> <li>Demonstrated flexibility, self-discipline and ability to work independently required.</li> <li>Ability to interact effectively with team members at various levels of management.</li> <li>Proven ability to operate under changing priorities and demonstrate flexibility and adaptability.</li> </ul> <br />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.