Jobs at BCBSM

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Displaying results 1 - 15 of 150

Project Consultant-Medicare Part D Pharmacy

BCBSM - Detroit, MI

DEPARTMENTAL SUMMARY Responsible for organizing and operationalizing immediate and ongoing tasks related to Medicare Part D pharmacy clinical programs. Interface with external and internal customers and vendors to identify and/or analyze business problems and develop solutions. Develop and improve workflows and business processes to improve cust...

Application Deadline: None

Health Care Analyst - Corporate Performance & Admin

BCBSM - Southfield, MI

Responsible for analyzing, monitoring, and reporting operational metrics and trends. Identify leading indicators and report to management. Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management. Research, analyze, identify, and evaluate data from assigned ...

Application Deadline: None

Claims Adjudicator

BCBSM - Grand Rapids, MI

BLUE CARE NETWORK OF MICHIGAN CLAIMS ADJUDICATOR(PROCESSOR) GRAND RAPIDS, MI Blue Care Network of Michigan is seekingClaims Processors who are responsible for the adjudication of medical claims at all pend levels in an accurate and timely manner as indicated by the corporate standard on accuracy and production standards. Responsible for the resolution of pended claims in an ac...

Application Deadline: None

Team Leader I Service Operations Contact Centers - Grand Rapids

BCBSM - Grand Rapids, MI

BLUE CROSS BLUE SHIELD OF MICHIGAN TEAM LEADER I STATEWIDE CALL-IN PRICING GRAND RAPIDS, MI Blue Cross Blue Shield of Michigan is seeking a Service Operations Team Leader I who will be responsible for the supervision of team members in the Pricing/Claims Contact Center Operation. Supe...

Application Deadline: None

Health Care Analyst- Facility Reimbursement

BCBSM - Detroit, MI

Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management. Department Summary: Proficient with OSCAR, CHCQES, EDW, BHI data to query, massage, analyze, and validate hospital claims data Strong understanding of CPT/HCPCS/DRG codes to...

Application Deadline: None

Med Review and Appeals RN

BCBSM - Southfield, MI

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach a...

Application Deadline: None

Sr. Rep. Employee/Labor Relations

BCBSM - Southfield, MI

Under minimal supervision, administer Employee/Labor Relations programs. Mitigate risk through the consistent and equitable application of policies and procedures consistent with the collective bargaining agreements and federal and state employment laws and regulations. Utilize corporate and employee policies and procedures to resolve complex employee and management inquiries t...

Application Deadline: None

Application Developer I

BCBSM - Detroit, MI

Blue Cross Blue Shield of Michigan is currently seeking an Application Developer II for our Detroit JeffersonThis individual will be responsible for the following: Departmental Requirements Prior experience in design and development of J2EE Technologies: (Java Frameworks, Content Management systems, Relational databases, Mobile technology...

Application Deadline: None

QA Analyst I

BCBSM - Detroit, MI

SUMMARY Schedule all telephony, move, add and change (MAC) work for all BCBSM and BCN campuses. Support all telephony projects and restacking efforts by attending meetings and creating / formatting cut sheets for technicians / vendors and facilities management. Process data equipment MAC work for Detroit and outstate facilities utilizing Service Catalog...

Application Deadline: None

Materials Proc

BCBSM - Detroit, MI

General Summary of Principle Duties Picks up and delivers various materials for BCBSM. Picks up materials from user areas for outgoing and inter-departmental shipments. Fills stock and non-stock requisitions and delivers materials to user areas. Assists in the loading and unloading of corporate and vendor vehicles. May package and ship outgoing merchandise. Qualifications

Application Deadline: None

Clinical Strategy Operations Manager

BCBSM - Detroit, MI

Responsible for researching, planning, organizing, directing, implementing, and management of corporate programs and initiatives dedicated to enhancing health care value. Position operates within broad objectives to ensure optimum utilization of manpower and budget. Specialize in research, planning, development, implementation and leadership. Department Summary: Manage...

Application Deadline: None

CSR II Lansing

BCBSM - Lansing, MI

BLUE CROSS BLUE SHIELD OF MICHIGAN Customer Service Representative II Lansing, MI Blue Cross Blue Shield of Michigan is seeking a Customer Service Representative to analyze, evaluate, resolve andrespond to customer/provider inquiries received via telephone, correspondenceor in person involving a variety of claim/benefit issues under various productlines. Will di...

Application Deadline: None

Analyst - Clinical Pharmacy Services-Blue Care Network

BCBSM - Southfield, MI

Provide functional technical and analytical support to BCNPharmacy Clinical Team. This may include problem identification and resolution, documentation, analysis, recommendation, and implementation of new or enhanced work processes, systems, and reports. Use Microsoft Office Access and Excel extensively to provide support through technical, analytical and subje...

Application Deadline: None

Analyst - National Section - Automated Group Reporting

BCBSM - Detroit, MI

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. Assist and support in the planning, coordinating, developing and implementing of approved pr...

Application Deadline: None

Technician - Automated Group Reporting

BCBSM - Detroit, MI

Responsible for providing administrative and technical support to assigned department(s). Assist supervisor and management with resolution of problems; conduct special assignments as requested and prepare reports and/or analysis, documenting the results with recommendations to management. Assist with the design, development, modification, testing, implementation and maintenance of assign...

Application Deadline: None