Senior Analyst - MA System Liaison

Blue Cross Blue Shield of Michigan•Detroit, MI

About The Position

Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision making capability. This includes developing or changing workflows and implementing process improvements to enhance organizational products, programs and service to our customers. Department Responsibilities: Design, develop, and implement new system claims logic for Medicare Advantage (MA) products. Configure MA benefit parameters within the claims processing platform, ensuring alignment with CMS guidelines. Perform detailed examinations of MA claims to verify accuracy, compliance, and proper reimbursement. Identify, document, and resolve defects in the claims processing system, collaborating with IT and NASCO, and vendor teams as needed. Stay current with CMS regulations, MA policy updates, and industry best practices related to claims processing. Analyze claim data to detect trends, root causes of errors, and opportunities for process improvement. Generate actionable recommendations and implement claim adjustment solutions to optimize payment accuracy. Produce regular reports and dashboards for stakeholders on claim performance, defect status, and resolution outcomes.

Requirements

Four (4) years of experience in a related field is required.
Excellent analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.
Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines.
Excellent verbal, written communication and interpersonal skills.
Ability to lead and contribute to business unit and/or corporate projects.
Proficient in Microsoft Office Suites.
Ability to develop and maintain effective working relationships.

Nice To Haves

Bachelor's Degree in a related field is preferred.

Responsibilities

Identify and analyze operational data and develop insights in support of business objectives.
Develop and improve work flows and business processes within defined areas to improve customer service, decrease operational costs and improve overall quality.
Identify and/or analyze business problems and develop recommendations for solutions to problems.
Lead the development and implementation of projects and/or teams in order to produce desired results.
Document and communicate project concepts, milestones and results.
Recommend and assist with implementing standard policies and procedures.
Ensure that corporate compliance is communicated, implemented and monitored on an ongoing basis.
Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.
Provide support to internal departments and external entities by answering questions, supplying information and training.
Create and present reports and presentations to display operational data and proposed business changes.
Design, develop, and implement new system claims logic for Medicare Advantage (MA) products.
Configure MA benefit parameters within the claims processing platform, ensuring alignment with CMS guidelines.
Perform detailed examinations of MA claims to verify accuracy, compliance, and proper reimbursement.
Identify, document, and resolve defects in the claims processing system, collaborating with IT and NASCO, and vendor teams as needed.
Stay current with CMS regulations, MA policy updates, and industry best practices related to claims processing.
Analyze claim data to detect trends, root causes of errors, and opportunities for process improvement.
Generate actionable recommendations and implement claim adjustment solutions to optimize payment accuracy.
Produce regular reports and dashboards for stakeholders on claim performance, defect status, and resolution outcomes.