Analytics Governance Team Summary: The Analytics Governance team, within the Analytics Center of Excellence, is responsible for establishing and overseeing enterprise standards for analytics methodologies, derived measures, tools, and Responsible AI practices.  The team manages analytics asset inventory, leads governance forums and risk management activities, and enables consistent, compliant, and well documented analytic practices across the enterprise. The Analytics Governance team, within the Analytics Center of Excellence, is responsible for establishing and overseeing enterprise standards for analytics methodologies, derived measures, tools, and Responsible AI practices.  The team manages analytics asset inventory, leads governance forums and risk management activities, and enables consistent, compliant, and well documented analytic practices across the enterprise. Departmental Responsibilities: Support Responsible AI governance activities, including...

Departmental Summary: The AI Engineer must have prior hands-on experience designing, building, and deploying Generative AI, Retrieval-Augmented Generation (RAG), and Agentic AI solutions within large-scale, big data environments. Proven experience delivering projects using Agile methodologies is a mandatory requirement. Key Responsibilities Design, develop, and implement end-to-end agentic AI systems that integrate:  Large Language Models (LLMs) Multi-agent orchestration frameworks Enterprise-grade data pipelines Business and operational applications Deliver production-grade solutions that meet enterprise standards for reliability, scalability, performance, and maintainability. Departmental Preferences: Hands-on development experience with:  Python, Python FastAPI Framework, Python Django AWS Bedrock AWS Bedrock Agent Core AWS SageMaker Catalog AWS SageMaker AI AWS SageMaker Model Monitor AWS SageMaker Studio Vector Databases (AWS...

SUMMARY: Effectively supervises the day-to-day work and team performance of the Non-Exempt Medical Only Claim Specialists to ensure the goals and customer service expectations are met. Acts as a direct supervisor for non-exempt claim professionals handling assigned claims. Responsible to supervise all aspects of this team and work with other departments as it relates to process, workflows, and continuous improvement opportunities which may cross departments. Identify ways to continuously improve claim process and workflows. Objectively evaluate opportunities against objective results or historically reports to support changes. Works with managers and employees to identify methods of improving employee performance and closing performance gaps. Responsible to work with peer Supervisors and Claim Management team to ensure all training is coordinated and delivered in a timely manner. Must know all training materials and have ability to deliver these materials with limited notice....

SUMMARY Responsible for the collection, evaluation and preparation of internal data and/or documents in support of investigation related to suspected fraud, waste, abuse, and error (FWA) within claims. Resolve non-prosecutable analyst cases and prepare and maintain department investigative files and case information systems. Assist in planning and special project activities as required by the Director, Manager and Senior Analyst.   DEPARTMENTAL PREFERENCES Seeking candidates with previous experience in clinical settings. This position focuses on clinical review of patient medical records and provider billing. Candidates must be able to interpret patient claims data for inconsistencies, completeness and quality.    ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned.    Identify instances of fraud, waste, abuse, or error in Blue Cross Blue Shield of Michigan (BCBSM) claims using Healthcare Fraud Shield, the...

Responsible for providing high-level, strategic engagement and education on product, pricing, and solutions. They will create deeper partnerships with our key agents while delivering an enhanced level of solution-oriented education and consultative interactions at an agency level. This role will be dedicated to key agent partners in the Michigan business segment. Provide support with the planning and execution of agent education summits and subsequent agency partnership meetings for identified key agencies. Support Michigan business sales teams by providing key talking points post summit meetings and PowerPoint templates for partnership meetings. Gather agency book of business data and curate Solution & Product marketing materials. Partner with stakeholders across the enterprise to help drive content delivery strategy for agents. Collaborate with communications specialist to ensure content is being shared in newsletters, portal, alerts,...

Determine individual risk acceptability, pricing, coverage, terms and conditions by developing, analyzing and evaluating information and exposures on risks of a technical nature for the garage line of business. Manage agency relationships. Serve as liaison with company personnel regarding company business opportunities and problem resolution. Provide input and assist in the execution of overall agency plan.  RESPONSIBILITIES / TASKS: Objectively analyze information on new and renewal business to accept, price, modify or reject business within the garage underwriting guidelines and letter of authority. Develop and maintain strong relationships with key agency partners. Demonstrate knowledge and understanding of garage coverage forms, rating plans, guidelines in the selection and pricing of individual risks. Effectively communicate and explain underwriting decisions to agents and internal stakeholders when necessary. Demonstrate knowledge and understanding of...

      This is a training level position aimed at acquiring the necessary skills and knowledge required to review enrollment and supporting documentation and decide to approve or deny the application based on applicable policy. Establishes, updates and maintains both subscriber and group records via direct input and/or manual transactions.  Sends standard correspondences. Successful completion of the first 90 days (quality/attendance/production etc.) will result in advancement to the Account Clerk II position. Review documentation to determine eligibility and review and approve, reject, or pend enrollment applications. Performs routine contract maintenance and/or billing updates in applicable system. Processes and clears transactions/write‑offs and output reports. Maintains files. Meets established quality and productivity standards. Responds appropriately and timely to telephone and written inquiries. Accurate self-reporting of daily activities. Perform other related...

SUMMARY: The Infrastructure Engineer II role is responsible for the operations of secure and highly available computing platforms, servers, and networks. This role is responsible for installing, maintaining, upgrading, and continuously improving the Company’s operating environment while maintaining the ongoing reliability, performance and support of the infrastructure. This includes monitoring the operating environments, responding to incidents, problems, supporting On-Call responsibilities and planning for growth.  Infrastructure Engineers deploy the release of new technologies as well as design, install, configure, maintain, and perform testing of server operating systems, networks, and related utilities and hardware. Additionally, this role’s responsibilities include troubleshooting problems as reported by users, supporting Web access and maintaining a secure systems environment.  GENERAL RESPONSIBILITIES/TASKS: May act as a technical project leader or provide...

Perform functions to include but not limited to business and systems analysis, application development and process improvement. Serve as a liaison between the business area and the IT organization when needed. Identify, document and communicate system and process changes necessary to improve system and operational performance measures.  Possess an in-depth knowledge of line of business while contributing to the identification, analysis and recommendation of technical process improvement initiatives. Support highly complex business processes requiring design or integration of technical solutions that may cross multiple functions of the business. Design, create and implement technical solutions. Serve as a lead role.   Business Analysis Conduct data gathering and analysis to understand business strategy requirements. Provide direction for short and long-term planning sessions and provide direction to ensure understanding of business goals and direction. Evaluate ongoing...

Customer Service Rep I Full-time Shift: 8:00 am to 5:00 pm Lansing, MI Assessment required-  Customer Service Rep   Blue Cross Blue Shield of Michigan is looking for outgoing, energetic, phone friendly individuals to work in a fast-pace call center environment. Our Customer Service Rep analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected inquiries.  Primarily evaluates membership...

Customer Service Rep I Full-time Shift: 8:00 am to 5:00 pm (Shift bidding process based on seniority) Grand Rapids, MI Assessment required-  Customer Service Rep   Blue Cross Blue Shield of Michigan is looking for outgoing, energetic, phone friendly individuals to work in a fast-pace call center environment. Our Customer Service Reps analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected...

Responsible to identify, prioritize and develop strategies to support Blue Cross Blue Shield of Michigan’s (BCBSM) competitive position, achieve positive business results, and improve the health and wellbeing of our members.  Responsible to make recommendations on consequential matters with long-term implications for the organization, including: setting enterprise aspirations and targets, developing enterprise-level strategies, assessing strategic investments and partnerships, and evaluating the enterprise’s overall portfolio of assets. Oversee or perform analyses including, but not limited to, financial modeling, claims analyses and complex statistical analyses.   Manage activities that are directly related to the corporate strategies, goals and objectives.     Utilize primary and secondary research to assist in identifying best practices and opportunities for the corporation.   Create executive level PowerPoint presentations and correspondence to...

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...

SUMMARY Provide leadership and direction to a claims operational team.  Act as a primary, independent, visionary and proactive authority; providing in-depth analysis of claims operational areas including statistical, industrial and regulatory perspectives.  Provide operational consistency and integrity to claims. Serve as a technical expert with regard to department operations. ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Directly manage and carry out managerial responsibilities in accordance with enterprise policies and applicable laws.  Responsibilities include interviewing, hiring and training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems. Plan, direct, manage and evaluate the day-to-day operations and workflow of production, claims management and customer teams. Consult with claims management across...

Customer Service Rep I Full-time Shift: 8:00 am to 8:00 pm  (Shift bidding process based on seniority) Detroit, MI Assessment required -  Customer Service Rep   Blue Cross Blue Shield of Michigan is looking for outgoing, energetic, phone friendly individuals to work in a fast-pace call center environment. Our Customer Service Reps analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected...

Customer Service Rep I Full-time Shift: 8:00 am to 8:00 pm  (Shift bidding process based on seniority) Grand Rapids, MI Assessment required -  Customer Service Rep   Blue Cross Blue Shield of Michigan is looking for outgoing, energetic, phone friendly individuals to work in a fast-pace call center environment. Our Customer Service Reps analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected...

The Executive Assistant will provide high-level administrative and operational support to the Senior Vice President, General Auditor, and Chief Compliance Officer. This position plays a key role in ensuring the efficient management of day-to-day activities within the Audit and Compliance functions. The individual will handle a variety of administrative tasks, manage complex calendars, prepare professional communications and documentation, and coordinate department operations.   This role will also assist with supporting meeting logistics, materials preparation, and follow-up actions associated with Audit Committee of the Board of Directors. The ideal candidate is highly organized, detail-oriented, and capable of handling confidential information with discretion and professionalism.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Provide executive-level administrative support including calendar management, travel...

The Service Operations Team Leader I will be responsible for the supervision of team members in the Contact Center Operation.  Supervision may occur onsite or remotely, therefore it is important for the Team Leader I to have the ability to perform the essential duties and responsibilities both onsite and remotely. Provide real time coaching, motivation, mentoring, development, recognition, and appraisal for assigned team member group.  This activity includes, but is not limited to:  Planning, prioritizing, and assigning work, team member face to face and virtual meetings to communicate performance objectives to staff and assist them in resolving problems through daily meetings, observing team member behavior by walking around, and listening to calls.  Provide first level leader support in chain of command with team members. Administer and adhere to corporate and departmental policies, practices and procedures, including union contract administration. Monitor...

SUMMARY:  Primarily responsible for the following:  Authority to evaluate which submitted vendor physical and phone audits and decide which require further analysis; approval, completion and processing mail audits; processing adjustments, and reviewing phone and physical audits requiring further review in a multi-functional business unit.  Provides direct customer service via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders. PRIMARY RESPONSIBILITIES: •   Actively engages in the identification of solutions for multiple or cross-functional business areas.  Has an understanding of the direction of the overall industry and evaluates the related impact. •   Evaluate and decide in a timely manner which vendor audits submitted require further review and provide...

Shift – Sunday - Thursday: 3:00pm-11:30pm Site/Location: Detroit, MI       Under general supervision, operates and controls all computing equipment relative to infrastructure and application processing. Operates computers and peripheral equipment as required. Controls application processing across all platforms adhering to production schedules. Completes batch job and infrastructure setup requirements. Updates processing logs and audit trails and keeps records of utilization. Develops and reviews Knowledge Management documentation for accuracy, may participate in training peers on all operational functions with the direction of supervision. Must be available to work any shift and schedule. Analysis of production control procedures to ensure compliance of timely batch processing.  Reruns and restarts production to ensure timely service levels and operating levels of agreement are met. Communicates the status of software, hardware and application processing and...