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. * Support the development, coordination, and implementation of projects to enhance the overall efficiency of operational procedures, methods, controls, and performance. * Compile and analyze operational data to identify and resolve business problems. * Utilize and maintain available reporting systems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process. * Provide leadership team with status updates on projects and issues. * Communicate and recommend policy changes to achieve project objectives. Assist in documenting departmental procedures. * Create and present reports and presentations to display operational data and propose business changes. * Provide support to both internal departments and external entities by answering questions, supplying information and training. * Participate on special projects or workgroups as assigned. "Qualifications" * Bachelor's Degree in a related field is preferred. * Two (2) years of experience in a related field is required. * Effective verbal, written communication and interpersonal skills. * Ability to work independently or in a team environment and interact with all levels of the organization. * Effective 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 coordinate multiple activities with varying timelines. * Proficient in Microsoft Office suites. * Ability to develop and maintain effective working relationships. Departmental Preferences: * Possess a comprehensive understanding and knowledge of the basic tenets of health insurance, the managed care model, Commercial (Facility and Professional lines of services), Coordination of Benefits, Medicare & Medicaid rules, claim adjudication process including clinical and medical billing and coding procedures and reimbursement practices. * Payment integrity systems knowledge preferred. * Knowledge of BCBSM and/or Blue Cross Blue Shield Association guidelines and regulation preferred. * Excellent analytical, decision making, organizational, planning, creative problem solving, and ability to work with minimal direction is preferred. 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.
