Most Recent BCBSM Job Listings

Department Summary:   Responsible for the lead role in implementing and administering professional and/or facility reimbursement policy. This is a multi-disciplinary role that will require mastery of reimbursement theory, fee/rate determination based on detailed formulas and calculations and loading, validating and publishing fee/rate schedules.  Administ...

Blue Care Network (BCN) has a Project Manager position available in Product and Process Improvement department located in Southfield, Michigan.  Supports various implementation activities on behalf of BCN and Blue Cross Blue Shield of MI (BCBSM).  Responsible for working with employees at all levels and supporting the Vice President of Product and Process Improvement and various project teams t...

Provide integrated enterprise-wide reporting of financial plans.  Analyze, evaluate, and maintain an understanding of client's business model/processes to ensure efficiency across functions and profitability across segments.  Influence positive change by providing consultation to clients regarding products, pricing, and financial arrangements.  Partner with business units to provide cos...

With general supervision, responsible for initiating, planning, executing, controlling, and closing application and system implementation projects using a formal project management methodology. Manage multiple moderate to large complex projects concurrently.  Oversee the system development lifecycle process for all projects. Develop detailed plans and schedules, including goals, risks, and r...

The selected candidate hired for this challenging position will be working with the team who is responsible for configuration of benefits for the Medicare Advantage program.  Familiarity with the ikaSystem claims module is preferred, however, hands-on experience with benefit configuration on another platform is acceptable, depending on experience and knowledge. Develop an...

Perform review of inpatient, outpatient, and ancillary services as required either on site or telephonically.  Perform review on admissions to ensure medical necessity, appropriate length of stay, appropriate intensity of service and level of care, and appropriate utilization of ancillary services.  Establish care plans and coordinate care through the health care co...

Responsible to help members to self manage and to modify behavior of specific chronic conditions, utilizing a collaborative process by supporting the physician or practitioner to enhance the patient relationship and plan of care.   Assess members’ knowledge and understanding of the self management of chronic conditions (Congestive Heart Failure, Chro...

Blue Cross Blue Shield of Michigan has an opening for a team leader in our Membership and Billing area located at the Renaissance Center in Detroit, Michigan.  This area is responsible for maintaining the membership records for customers.  This supervisor position will coach and mentor a team of 12 – 15 bargaining unit employees who are responsible for processing membership updates t...

This position is responsible for maintenance functions and activities related to several automated and Web applications which include Online Benefit Information (OBI) and Summary of Benefits and Coverage (SBC) which must be maintained in accordance with established corporate policies and national health care reform mandates and government compliance requirements.  Also, responsible for ...

  Departmental Summary:  Perform a broad range of administrative duties for Sr. Director, Workforce Diversity and department.  This position would be responsible for managing the calendar and email for the Sr Director including monitoring, scheduling and coordinating appointments/meetings to ensure priorities are met.   Act as a liaison with DI Diversity...

  Responsible to plan, organize, direct, control, and lead assigned business unit; specialize in development, planning, and leadership; operate within broad objectives to ensure optimum utilization of capital, manpower, and equipment for the assigned business unit.    Excellent working knowledge of Medicare Part D regulations. Previous exp...

  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.   Utilize data analyti...

Departmental Summary:  This position is a member of the Talent Management team and will be working with Blue Performance and other HR systems.    Current projects include Blue Performance release testing, Blue Performance end user support, talent inventory reporting and analysis, performance management reporting and other ad hoc reporting/analysis ...

  Responsible to plan, develop, write and edit superior communications content for corporate publications and marketing collateral supporting corporate strategies, products and business objectives, and reinforcing company culture, vision and values.   Work as internal business partner to develop and provide communications to functional level b...

The Medical Social Worker is responsible for evaluating, developing and coordinating care management services related to the patient’s/family’s psychosocial needs, as well as medical care needs, for identified at-risk member’s.  In addition to the member or designee, these efforts are coordinated with the member’s personal care physician (PCP) and the nurse Case Manager (as indicated...