11 claims analyst jobs found in Detroit

SUMMARY:    The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments.  This position operates within broad objectives to ensure optimum utilization of manpower and budget.  This role researches, compiles, and analyzes appropriate and relevant data and makes recommendations for operational improvements.  RESPONSIBILITIES/TASKS:  Support PBM transition tasks and participate in workstream meetings Supports PBM audit and analytics to support Medicare pharmacy services business team.  Builds and supports business reports to be included in executive dashboard. Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues. Possesses and maintains an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional...

Departmental Summary: The Application Developer II will support ancillary lines of business Dental, Vision, EOB IT, CDH and Pharmacy, ensuring reliable execution of production processes and day-to-day operational stability. Responsibilities include monitoring and supporting batch and real-time workflows, triaging and resolving defects, and implementing enhancements to core business logic in alignment with evolving business needs and compliance   requirements . The role will participate in initiatives such as claims processing, membership reporting and reconciliation, and benefit updates, emphasizing accuracy, timeliness, data quality, and SLA adherence. This position will also contribute to strategic initiatives across Dental, Vision, and CDH products. As part of ongoing modernization, the analyst will help transition business functionality to distributed platforms and services (e.g., APIs, microservices, data pipelines), including analyzing existing logic and...

Perform technology 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. Design, create and implement technical solutions. Support complex business processes. 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 department activity and propose new tools or technologies Assist in the business process redesign and documentation as needed for new technology....

SUMMARY:     Workers Compensation Defense Attorney needed for in-house litigation position, working under the direction of the General Counsel.  This position will work defending litigated Workers’ Compensation claims before hearing locations, primarily in and surrounding Detroit, MI. This attorney will conduct research where necessary, examine records, conducts investigations, attends depositions, consult with witnesses, insured(s), legal assistants, and/or personnel.  Participate in negotiations on behalf of the Company including settlements.  In addition, this position will provide leadership and expertise on major company projects as necessary. Claims Focus:  This position will provide  state specific legal representation before courts, arbitration panels and/or administrative bodies.  Serve in an advisory capacity to company and employees.  Prepare legal pleadings, motions, memorandums, trial briefs, etc. Conduct research where necessary, examine records, attend...

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...

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:   This is a hybrid position reporting to our Detroit office 2 days a week. Associate Attorney – AAA/The Auto Club Group Reports to: Supervising Practice Leader Under moderate supervision, handle litigation and cases of intermediate-level exposure and complexity in which the insured or the Company is a defendant.  Able to transition from courts of limited exposure to courts of unlimited exposure.  Develops and applies skills to control all aspects of litigation, including trial preparation, discovery, negotiation, presentation and appeals from District to Circuit Court.  Primary Duties and Responsibilities (details of the basic job functions): Reviews and analyzes files, insurance policies, all allegations and pertinent medical and technical...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Auto Field Appraiser- Detroit or Lansing, MI PRIMARY PURPOSE : To handle field appraisal assignments for our corporate fleets and insurance clients with an emphasis on Auto's. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Set appointments same day, inspect within 24 hours and write estimate car side Depending on location - appraiser is expected to write 6 to 10 estimates per day Ensures proper vehicle tear down Determine repair time allotments and required labor...

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:   This is a hybrid position reporting to our Detroit office 2 days a week. Senior Trial Attorney – AAA/The Auto Club Group Reports to: Supervising Practice Leader Responsible for litigation of Circuit and Federal cases of unlimited exposure where there is a multiplicity of complicated legal and factual issues involving the more serious injuries, excess damages, and high exposure litigation of identified legal issues which the Company may pursue through the appeal process.  Primary Duties and Responsibilities: Case Management and Preparation: Analyzes, files, reviews all allegations, and renders legal opinions to Claims personnel regarding evaluation and disposition of injury cases. Prepares responses to civil complaints, files and...

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...

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...

The Director, Government Programs- Data & Engineering drives the execution of data use and adoption for Government Programs and CFO areas. This role promotes the use of AI, automation, and best-in-class technology across teams; will partner with business, technology, product, and operations leadership to lead the delivery of business imperatives. The Director will ensure access to accurate and high-quality data and provide support for reporting, analytics, and modeling across finance, controller, actuarial, UW, and Government Programs. The role leads the design of member level constructs across CFO, Commercial, MA, JVs. The Director also supports working with IT and ensuring migration of off legacy analytics systems (CADE/IDAP) as well as support for reporting and visualization creation working with business partners. Drive coordination with enterprise stakeholders (e.g., IT, ACoE) alongside the Actuarial, Finance, Underwriting, and Government Programs Planning...