Manager - Payment Integrity Operations

Blue Cross Blue Shield of Michigan • Detroit, MI

1d

About The Position

Responsible for planning, organizing and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems.

Requirements

• Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred.
• Five (5) years of experience in a related field is required.
• Previous experience leading projects and/or teams is required.
• Ability to effectively lead, coach and develop team members.
• Ability to work effectively in a team environment.
• Strong organizational, planning, analytical, and problem-solving skills.
• Working knowledge of corporate organizational structures, including functional responsibilities.
• Strong verbal, written communication and interpersonal skills.
• Ability to manage multiple priorities concurrently.
• Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.
• Ability to interface and present to all levels of the organization.
• Ability to build relationships and work collaboratively with cross-functional teams.

Nice To Haves

• Five (5) years related work experience in all lines of business, preferably in Claims Operations: Commercial PPO, HMO and Medicare product related work experience within a healthcare organization or equivalent combination of transferable experience and education is preferred.
• Seven (7) years Claim platform experience in Nasco-NPS and/or Facets is preferred.
• Demonstrated knowledge of Payment Integrity programs is preferred.
• Medical coding certification preferred is preferred.
• Extensive working knowledge and demonstrated subject matter expertise in the areas of Federal, State and BCBSA regulatory mandates and compliance programs is preferred,
• Ability to utilize functional and industry knowledge to efficiently and independently identify and build solutions for complex enterprise and product strategy issues related to Payment Integrity and Claims. is preferred
• Strong problem-solving and analytical skills as well as strong business acumen of healthcare claims with an emphasis on Payment Integrity is preferred.

Responsibilities

• Manage activities of a department including, but not limited to planning, problem solving, staff development and communication.
• Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement.
• Lead, direct, evaluate and develop the work of assigned employees.
• Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes.
• Provide effective and efficient solutions to complex business problems
• Ensure that day to day business unit operations align with organizational objectives.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees