7 claim operations analyst jobs found in Detroit

Departmental Summary: This position supports Medicare Part D pharmacy quality and medication adherence initiatives through data analysis, reporting, dashboard development, and operational support. Responsibilities include analyzing healthcare data, monitoring quality measures, providing actionable insights to business and clinical partners, and supporting initiatives that improve CMS Star Ratings. Required Skills and Qualifications: • Strong experience developing complex SQL queries and analyzing large healthcare datasets, including pharmacy claims, medical claims, membership, and provider data. • Proficiency in Python for healthcare analytics, reporting, process automation, and data quality validation. • Experience in writing and maintaining Spark SQL and Python code in Databricks to support process automation and data analytics • Familiarity with SAS programming for data manipulation, reporting, and analytics. • Strong Tableau experience in...

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. 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...

Departmental Summary This role is responsible for duties within the Epic platform, including design, configuration, customization, testing, deployment, support, and optimization of assigned Epic application areas or modules. The position partners with clients, stakeholders, Epic representatives, analysts, and IT teams to translate operational workflow needs into Epic-based solutions that align with BCBSM business and project objectives. Departmental Requirements Candidates must have relevant experience in application analysis, application support, systems implementation, configuration, testing, or related IT/business systems work. Experience supporting healthcare payer operations, including clinical data, care management, utilization management, claims, or other health plan functions, is preferred. Prior Epic implementation experience is desirable. Epic certification is required; candidates without certification may be considered if they are willing to complete the...

Responsible for planning, coordinating, and supervising all administrative, operative and employee functions within assigned area(s) to ensure an efficient and cost effective area in accordance with departmental and corporate standards and objectives. Supervise, coordinate, direct and monitor staff activities to ensure prompt, courteous and accurate response to customers; ensure an efficient and qualitative operation through effective planning, leading, controlling and organizing. Prioritize and assign work to employees and initiate corrective measures to resolve problems including scheduling or adjusting overtime requirements as necessary. Select, train, develop, appraise and counsel support staff personnel. Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries. Monitor and analyze proficiency and quality efforts subordinate personnel. Administer and adhere to...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Detroit, Michigan – Wayne, Oakland, and Macomb County Position Schedule / Shift: Hybrid – Field schedule Monday – Friday: 8:30 AM EST – 5:30 PM EST. Position Summary: Join our team as a Field Property Claim Specialist serving the Metro Detroit area, where you’ll be the face of our claims experience and make a meaningful difference for customers during challenging times. In this role, you’ll inspect property damage, investigate claims, and work directly with homeowners to provide exceptional service and fair claim resolutions. If you enjoy working independently, building relationships, and combining problem-solving skills with field-based work, this is an opportunity to grow your career while helping customers recover and move forward. Key Responsibilities: Reviewing assigned claims Contacting the insured and other affected parties Setting...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Eligible candidates must reside within the metro Detroit Michigan area for consideration and have a valid state driver's license. Preferred candidates should reside in Oakland, Macomb, or Wayne County. Metro Detroit Field Property Claim Specialist -AAA The Auto Club Group Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Eligible candidates for this role must reside within a commutable distance of the Oakland County Detroit, Michigan area for consideration and have a valid state driver's license. Metro Detroit Field Property Claim Specialist -AAA The Auto Club Group Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create additional sub-claims if...