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....

Responsible for the retention and growth of existing and assigned accounts in support of organizational strategic, financial and performance goals by executing on core sales and business development activities such as strategic account/agency planning, sales consultations, identification of sales opportunities, and renewal support. Responsible for managing local accounts through agency or consultant interfacing Develop, refresh, and execute multi-year strategic account/agency plans to grow and retain the account and relationships, including identifying key opportunities, risks, and mitigation strategies. Present internal strategic account/agency plans to leadership team as well as external plans to accounts or agencies/consultants for review and alignment. Leverage strategic account/agency plans to drive annual strategic discussions and other strategic planning efforts with accounts. Deliver account specific advice on plan benefit design,...

The Release Train Engineer (RTE) is the servant leader and coach for an Agile Release Train (ART), enabling cross-functional teams to effectively plan, execute, and continuously improve the delivery of business value. The RTE partners with Product Management, Product Owners, Scrum Masters, Business Owners, System Architects, and Agile Teams to foster alignment, remove impediments, and improve flow across the ART. This role champions the foundational principles and values of the Scaled Agile Framework (SAFe), promoting a culture of collaboration, transparency, continuous learning, and servant leadership. While primarily focused on the flow and effectiveness of the Agile Release Train, the RTE also partners with Enterprise Agile leadership to advance Lean-Agile practices and contribute to the organization's broader delivery of value. Experienced Lean-Agile leader who enables high-performing teams through influence rather than authority. Excel at facilitating alignment towards...

  SUMMARY:     Responsible for the proactive management of worker’s compensation subrogation claims. Exercises significant discretion in the determination of liability and value of claim.     Negotiates and settles with claimants and/or attorneys, within authority, at earliest possible point to bring cases to final disposition.   RESPONSIBILITIES/TASKS: Investigates, analyzes, determines potential liability, and effectively settles with adverse parties.  Completes other duties and special projects as requested. Recommends, plans and advocates a position on workers compensation subrogation claims assigned. Develops and manages subrogation claim action plans to resolution, coordinates claim processes and approves claim payments. Supports the team by acting as back up to the Subrogation Examiner II and Senior. Updates databases and prepares reports utilizing standard software. Communicates and collaborates with workers compensation claims...

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   Responsible for providing consultation and training to employers regarding safety matters. Develop business partnership and ambassador-type relationship with insured policyholders. Evaluate physical premises, equipment, materials, work practices, and safety policies and programs.  Conduct safety surveys of employers’ premises to gather information to assist in risk selection as an integral part of the underwriting process. Work with management to develop loss control strategies that will have the greatest impact on company success measures. This position involves field-based work requiring travel within the assigned market/territory. Residency within or in close proximity to the designated market is required to support job responsibilities. ESSENTIAL DUTIES AND RESPONSIBILITIES  Other duties may be assigned. Review business processes and operations to identify hazardous conditions and unsafe acts that may adversely impact employee claims....

Conduct compliance investigations and lead the execution of moderately complex initiatives for Blue Cross Blue Shield of Michigan (BCBSM) and its subsidiaries. Analyze and develop documentation to support regulatory changes and departmental policies and procedures. Conduct comprehensive and moderately complex regulatory analyses to include the review, summarization and dissemination of compliance reports. Provide support and recommendations for privacy investigations to mitigate business risk. Develop work flows to define the documentation of department processes, report generation, and process improvements. Define assigned project scope and deliverables to support compliance initiatives. Partner with the business to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics and processes. Promote compliance awareness by supporting training, programs and departmental activities. Provide support or lead government audit requests...

Supports the overall improvement of members health status in collaboration with the case managers and physicians by identifying and referring members to community resources, counseling and/or support services. Educates members about entitlement programs, legal issues, or other services relevant to social work practice skills and knowledge. Work in partnership with the member and community partnerships to develop and implement a plan of care. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum. Consult and coordinate with the case manager and physician to identify member issues and develop a plan to resolve the issues. Utilize available government, community and/or employer group resources to address member’s unique needs. Facilitate and coordinate Behavioral Health resources as individual needs are identified. Manage behavioral, psychosocial needs and deliver...

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   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 issues/inquiries and price/adjudicates low complexity claims/inquiries.  Interact with others inside and outside the organization to...

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   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 issues/inquiries and price/adjudicates low complexity claims/inquiries.  Interact with others inside and outside the...

SUMMARY This position is responsible for performing advanced actuarial analyses, designing and preparing exhibits, developing appropriate recommendations, and communicating with business partners and senior management. Mentors and trains actuarial analysts. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. •    Perform actuarial analyses for pricing, loss reserving, product development, reinsurance, capital management, and/or other financial or business purposes.   •    Communicate effectively: Make recommendations and present findings to appropriate audiences via creation of presentations, reports and pricing tools as applicable. •    Document all work and establish or improve procedures for internal department processes. •    Help design, enhance, and maintain pricing, reserving, reinsurance and forecasting models. •    Work with various business units to help create and drive strategic plans and metrics. •    Monitor premium and loss...

The Internship Program at BCBSM is designed to enhance the skills and abilities of young professionals as well as to identify and attract future talent for our organization. Interns will gain practical hands-on work experience as well as a solid understanding of the health insurance industry. Our program is an excellent way for interns to get a good start on their careers by working on meaningful projects, learning valuable skills, and networking with employees throughout our organization, which could potentially allow interns to build a future career at BCBSM. Assist in preparing information and research materials to identify business problems, offer recommendations and assist  management with implementation of solutions.  Support leaders on projects designed to enhance the overall efficiency and effectiveness of the organization. Develop and maintain a solid understanding of BCBSM business, products, programs, data, organizational structure, controls, research.  Analyze...

SUMMARY   The Senior Nurse Case Manager (SNCM) role within the Claims Department is to assist management and the claims team in supporting strategic initiatives and achieving annual claims goals. This position is responsible for applying medical knowledge in reviewing complex workers’ compensation claims to determine causal nature of patient’s symptoms, medical necessity/reasonableness of treatment, facilitate claimants’ return to work (RTW) and propose alternative care arrangements.  SNCM assists in development of new medical cost containment programs and projects as well as taking a leadership role in the implementation and ongoing support of these initiatives. The SNCM utilizes competence, positive communication skills, problem solving and conflict resolution techniques. The SNCM demonstrates strong organization and time management skills with the ability to affect change when necessary. This role may execute their essential functions telephonically or as a Field NCM...

At AF Group, our affiliate brands deliver innovative insurance solutions and exceptional customer experiences. Consistently recognized by Business Insurance as one of the industry’s “Best Places to Work,” we are proud of our culture and the talented people who make it possible. Join us—and let’s do amazing things together. SUMMARY: Responsible for performing both virtual and field premium audits within a multi-functional business unit, with a primary focus on Workers’ Compensation and General Liability policies, and operating within established authority levels. Reviews accounting and financial records to accurately determine exposure and premium for policyholders’ employees and subcontractors. RESPONSIBILITIES/TASKS:  Performs virtual and field audits, within established authority level. Contacts agents to review audit results, prior to invoicing on large accounts. Collects all pertinent data and documents needed to calculate policyholder’s premium liability....

Summary Assists customers in solving operating problems and systems-related malfunctions with all company operations and automated systems.  Act as a liaison in the development and maintenance of system and procedures.  Serve as a liaison with outside vendors and external customers that use our systems. Develop or assist in the preparation of user needs and requirements.   Responsibilities/Task Direct system support relative to the activities related to the Support Desk.  Responsible for first level support for client operating systems and application software Review changes to existing procedures for Support Desk Manuals, audit all procedures. Maintain liaison with all divisions within organization to keep abreast of their needs and concerns. Determine service level agreements with all divisions and assign work to ensure that service level is met. Represent the department on task forces and cross-functional teams that impact the Support Desk.  Work...

Responsible   for   planning,   organizing,   directing,   implementation,   and   leading   department   assignments. Position operates within broad objectives to ensure optimum utilization of manpower and budget. Research,   compile   and   analyze   appropriate   and   relevant data   and   make   recommendations   for operational improvements.   Within Clinical Data Strategy & Operations team, the position also provides strategic leadership for clinical data acquisition, exchange, interoperability, adoption, governance, and value realization. ESSENTIAL   DUTIES   AND   RESPONSIBILITIES   include   the   following.   Other   duties   may   be assigned. Leads   in   the   research,   analysis,   identification   and   evaluation   of   data   from   assigned   problems   to evaluate existing and potential trends and issues. Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, programs   (including   provider...

Help shape the future of Finance through AI. As an AI Transformation Engineer for Finance, you’ll partner with Enterprise Accounting, Finance Technology, Analytics, and business stakeholders to design, pilot, and scale AI-enabled solutions that modernize controllership workflows. You’ll identify high-value opportunities to combine artificial intelligence, automation, analytics, and workflow redesign to reduce manual effort, accelerate cycle times, strengthen controls, and improve the finance user experience. Working across accounting, reporting, tax, audit, and internal controls, you’ll translate business needs into clear requirements, solution designs, use cases, testing criteria, and adoption plans. You’ll also help put responsible AI into practice, ensuring solutions are practical, well-controlled, auditable, and aligned with enterprise policies, data standards, risk expectations, and human-review requirements. Ready to turn complex finance challenges into meaningful...

Turn numbers into insights that drive business decisions at Blue Cross Blue Shield of Michigan. In this role, you’ll work with teams across the organization to explore financial results, monitor revenue and expenses, and bring together data to tell a clear financial story. Your work will include reconciling accounts, preparing reports and supporting budgets, audits and regulatory reporting. If you enjoy making sense of numbers and collaborating with others, we’d love to hear from you. Explore this opportunity and apply today. Prepares financial information and reviews for accuracy and completeness.  Performs detailed analysis when necessary. Other deliverables may include account reconciliations, impact studies, audit findings, budgets and business cases.  Assists with the preparation of various financial or regulatory reports and/or statements for management and/or parties external to BCBSM (e.g., auditors, customers, providers, BCBSA, FEP, OFIS, etc). Prepares...

SUMMARY This is the intermediate level of the claims handling career path responsible for managing a caseload of Michigan No-Fault Personal Injury Protection (PIP) claims of moderate to high complexity. The Claim Representative II investigates and administers both litigated and non-litigated PIP claims, exercising independent judgment in coverage analysis, compensability determinations, exposure evaluation, and claim resolution. The position requires thorough knowledge of Michigan No-Fault law, including order of priority investigations, coverage verification, injury causation analysis, and litigation management. The Claim Representative II collaborates regularly with insureds, claimants, healthcare providers, attorneys, and internal business partners to ensure timely, accurate, and compliant claim handling. This fully remote opportunity is available for candidates residing in Michigan.   RESPONSIBILITIES/TASKS:   Determines compensability under Michigan Assigned...

SUMMARY   The Senior Nurse Case Manager (SNCM) role within the Claims Department is to assist management and the claims team in supporting strategic initiatives and achieving annual claims goals. This position is responsible for applying medical knowledge in reviewing complex workers’ compensation claims to determine causal nature of patient’s symptoms, medical necessity/reasonableness of treatment, facilitate claimants’ return to work (RTW) and propose alternative care arrangements.  SNCM assists in development of new medical cost containment programs and projects as well as taking a leadership role in the implementation and ongoing support of these initiatives. The SNCM utilizes competence, positive communication skills, problem solving and conflict resolution techniques. The SNCM demonstrates strong organization and time management skills with the ability to affect change when necessary. This role may execute their essential functions telephonically or as a Field NCM...