Sr Medical Analyst - Key State Accounts

<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.

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Competitive Total Compensation Package

Overview: The senior medical analyst provides medical policy analysis and clinical expertise to the department&rsquo;s account managers and group customers including: Research and consult with subject matter experts on medical policy and utilization inquiries. Represent the department in corporate workgroups including CARIT, JUMP, BCR and Medical Affairs meetings. Monitor changes to covered preventive services and update preventive services documents for the State&rsquo;s active and retiree membership population. Attend statewide retiree meetings to present information on value-added services offered by Blue Cross including Case Management and Online Wellness (WebMD). Educate members on preventive care, skilled nursing and private duty nursing. The ideal candidate is a customer-focused, self-starter who will engage well with group customers and educate members on a variety of health topics.
Responsibilities: <ul> <li>Leadership responsibility to coordinate the development and implementation of programs and strategies to improve service to our customers.</li> <li>Develop and improve work flows and business processes within area(s) to improve customer service, decrease operational costs and improve overall quality.</li> <li>Identify and/or analyze business problems and devise procedures for solutions to the problems. Effectively lead projects/teams in order to produce desired results.</li> <li>Responsible for corporate communication of project results.</li> <li>Recommend and assist with implementing standard policies and procedures for providing routine service.</li> <li>Assure that corporate compliance is communicated, implemented and monitored on an ongoing basis.</li> <li>Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.</li> <li>Assist personnel (both internal and external) by answering questions, supplying information and training.</li> <li>Develop and maintain an effective working relationship with customers.</li> <li>Other duties may be assigned.</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>Supervisory and/or Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities.</li> <li>Ability to plan, organize, direct and control projects.</li> <li>Excellent written and verbal communication skills.</li> <li>Ability to lead and contribute to process improvement projects.</li> <li>Working knowledge of PC applications and/or mainframe required.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <strong><span style="text-decoration: underline;">DEPARTMENT PREFERENCES:</span></strong><br /> <ul> <li>Two (2) to four (4) years of clinical experience preferred.</li> <li>Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.</li> </ul> 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.