30 operations analyst jobs found in Detroit

Provides technical, data and analytical support to customer departments such as Quality, Value Partnerships, Hospital Contracting, Care Management, Risk Adjustment and HCV.   ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned.  Leads or participates, with some direction, in projects where data solutions are necessary. Provides programming and data expertise for simple and moderately complex projects and ad-hoc requests.   Presents data and solutions to internal and/or external customers in a logical way. Provides data support and analysis for programs supporting over 4 million BCBSM beneficiaries using administrative claims and supplemental data.    Provides analysis and data support for various corporate departments including Quality, Risk Adjustment, Value Partnership, Care Management, and Hospital Contracting, in support of major corporate initiatives such as EMR Connectivity, PGIP, Risk Adjustment, STARS and...

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...

Position Summary Responsible for planning, organizing, directing, and executing complex analytical initiatives that support Health Care Value programs and performance management activities. This position operates with a high degree of independence and is responsible for researching, analyzing, and interpreting healthcare data to identify trends, evaluate program performance, quantify savings, and provide actionable business recommendations. The Senior Healthcare Analyst partners with internal stakeholders, vendors, providers, and leadership teams to develop analytical solutions, monitor contractual performance, and deliver strategic insights that improve healthcare affordability, quality, and operational effectiveness. Key Responsibilities Healthcare Analytics & Performance Measurement Lead the research, analysis, and evaluation of healthcare claims, authorization, utilization, provider, and membership data to identify trends, risks, and opportunities....

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...

Provide support to all phases of the application development process to include business analysis, application, architecture, design, development, integration and delivery for those business applications that support the administrative or operational functions of the company or the business applications needed to serve customers effectively.  Provide business application maintenance and support.   Work closely with clients, business analysts and team members on moderately complex to complex programming projects. Define business processes and gather project requirements. Write software code, test, debug, and document and maintain computer applications. Identify coding errors through informal and formal testing methods.  Ensure application integrity by applying SDLC concepts. Provide ongoing maintenance of applications. Document functions and changes to new or modified modules and test activities/results. Identify technical requirements, as needed. Create technical design...

Responsible for developing and conducting formal classroom training delivery, providing on-the-job training (OJT) and post-training support, and developing training materials and programs. Plan, coordinate, develop and implement approved projects which are Divisional and/or Corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls and performance. Responsible for compiling and reporting trainee performance up to various levels of leadership, following each training course.  Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives. Assist personnel (both internal and external) by answering questions, supplying information and training in assigned area(s). Represent department and division as requested on work groups and special assignments, including related testing. Function as subject matter expert on divisional work groups and act as a...

Department Preferences 3–5 years of healthcare experience 1–2 years of experience creating and distributing reports Demonstrated ability to interpret data and recommend an appropriate course of action 1–2 years of experience with Risk Adjustment programs   Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that affect profitability, growth, and productivity of corporate initiatives.  Coordinate projects for senior management. Develop, design, and administer methods and procedures to assess operational effectiveness of organization.  Identify, analyze, and monitor issues/trends that affect profitability, growth and productivity to assist in developing long term goals and strategic objectives.  Maintain knowledge of field's concepts, practices, and procedures.  Coordinate, direct and monitor assigned projects and ensure an efficient and qualitative operation through effective planning, controlling and...

Why GM Financial Technology? Innovation isn’t just a talking point at GM Financial, it’s how we operate. From generative AI and cloud-native technologies to peer-led learning and hackathons, our tech teams are building real solutions that make a difference. We’re committed to AI-powered transformation, using advanced machine learning and automation to help us reimagine customer interactions and modernize operations, positioning GM Financial as a leader in digital innovation within a dynamic industry. Join us and discover a workplace where your ideas matter, your development is prioritized, and you can truly make a global impact. About The Role: This role is responsible for building the organizational capability to deliver effectively and predictably, with high-quality execution across the portfolio and alignment to the Product Operating Model. Through coaching, delivery insights, and continuous improvement, the role enables teams to increase flow, quality, 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....

This position is located in Detroit, MI or Grand Rapids, MI This position is responsible for designing and developing procedural documentation, formal training modules, customer service alerts and conducting training and/or Train-the-Trainer sessions for Claims Training Division team members. This position demands that the incumbent works closely with managerial and supervisory-levels as well as Subject Matter Experts in order to assess needs and performance and to validate and evaluate training materials, to include representing the Department on various Committees and Workgroups. This position is responsible for developing, coordinating and managing Training Schedules for the Core Operations Claims Division. Works closely with the Training Team, Quality, Divisional Leadership and other Subject Matter Experts in order to analyze performance/new business issues and develop appropriate procedural documentation and training support materials.  Represents the Department on...

Department Summary This role requires a highly accountable, detail-oriented professional who can independently lead complex, time-sensitive work in a fast-paced, highly visible customer environment. The successful candidate will demonstrate strong project management, critical thinking, sound judgment, and exceptional attention to detail, with the ability to anticipate issues, manage competing priorities, and consistently deliver accurate, high-quality work under tight deadlines. The individual must be a confident communicator who takes ownership, drives accountability across teams and partners, asks the right questions, and translates complex issues into clear, complete responses for the customer and executives. Strong preparation, follow-through,  and the ability to constructively challenge and influence others are essential. Experience applying Six Sigma methodologies to solve problems, identify root causes, and improve processes highly preferred. Accountable for and...

Shift – 7:00am-3:30pm M-F Site/Location: Detroit, MI     This position is responsible for the safe, reliable, and efficient installation, operation and maintenance of data/voice premise distribution systems and electrical distribution systems, and a variety of facility systems and components critical to servicing company internal and external customers. Respond to all site emergencies, implement industry and corporate standards into the workplace, and provide documentation for all data, voice and electrical systems. Perform an assortment of duties related to the design, installation, maintenance, troubleshooting and repair of building electrical systems, communication systems, and equipment. Perform duties in a manner that maximizes efficiency, employee and environmental safety, and continuity of services to facility occupants. Perform preventative maintenance and repairs to a wide variety of systems and components. Complete an assortment of tasks and projects using...

The Executive Services Intern will support the department by strengthening reporting operations, improving procedural consistency, and contributing to key departmental initiatives. In this role, the intern will review existing reporting procedures to identify opportunities for greater accuracy, efficiency, and standardization, assist in producing timely and reliable reports for leadership and internal stakeholders, and provide support for ongoing projects within the department. As an intern you will:  Assist with the preparation, production, and distribution of recurring and ad hoc reports for leadership and internal stakeholders. Review existing departmental reporting procedures. Analyze data and trends to support reliable reporting and informed decision-making Support departmental projects by tracking deliverables, monitoring timelines, and coordinating follow-up activities. Have strong project management skills    The Internship Program at BCBSM is designed to enhance...

SUMMARY: Join two teams working together to support quality healthcare operations and a positive member experience. As a shared intern supporting MA Communications Quality and Vendor Oversight , you will gain hands-on experience reviewing member communications, supporting quality assurance, assisting with vendor contracts and performance oversight, and contributing to process-improvement projects. You will collaborate with teams across the organization while building practical skills in communication, project management, data analysis and problem-solving. JOB DESCRIPTION: Support quality assurance and vendor oversight activities by evaluating communications, documentation, processes, and vendor performance against approved requirements, contractual obligations, company policies, and applicable healthcare regulations.  Review Medicare Advantage member communications and vendor-related materials to identify inaccuracies, inconsistencies, compliance concerns, and...

Job Type: Full time   Exempt/Non Exempt:   Hourly Job Description:   Location: Dearborn, Michigan   Position Schedule / Shift: Rotating hybrid schedule Monday – Friday: 8:30 AM EST – 5:00 PM EST. In office reporting will rotate based on role responsibilities. All employees will be notified of in office reporting days as applicable. Training for this position will be in office for the first initial 90 days of employment. Rotating schedule will begin after training is completed. Position Summary: Join our Claims team in a role where your analytical skills, attention to detail, and problem-solving abilities make a direct impact on the customer experience and the financial integrity of our claims operations. As a claims operations professional, you'll take ownership of complex payment and reconciliation processes, resolve challenging issues, and serve as a trusted resource for teammates while helping ensure accurate, timely claim outcomes. If you...

Departmental Preferred Qualifications: Leads complex, cross-functional projects and coordinates internal and vendor resources. Manages project scope, timelines, budgets, risks, metrics, testing, implementation, and deliverables. Resolves barriers, improves processes, and ensures quality execution. Demonstrates NASCO system and operational knowledge, including GDO and SBP projects. Provides expertise in MAPPO, Commercial, HMO, and PPO products. Manages benefit administration, implementation, configuration, validation, and testing. Demonstrates strong organizational skills and sound judgment in ambiguous situations. Possesses customer service knowledge and may guide or supervise staff while performing other assigned duties. Communicates effectively and confidently with external customers and organizational leadership.   Accountable for and manages the development, implementation and ongoing maintenance of long-term project(s) typically spanning two years or more...

Join the Health Care Value Strategic Informatics and Program Performance team where you will be responsible for leveraging advanced analytics, predictive modeling, and data visualization to generate actionable insights that improve healthcare outcomes, optimize program performance, and support strategic decision-making. This role partners with business leaders, clinical teams, pharmacy services, and operational stakeholders to analyze healthcare data, identify trends, evaluate program effectiveness, and provide data-driven recommendations related to cost, quality, utilization, and member outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Analyze large volume of health care claims data using advanced statistics/machine learning methods to understand existing and predict future health care trends and anomalies. Proactively discovers potential areas for medical cost improvement and management/healthcare initiative strategies....

SUMMARY:  The purpose of the Medicare Part D PGY1 residency program is to empower and educate the resident in all areas of Medicare Part D practice, including but not limited to:  • Formulary Management (including Rebates)  • Pharmacy and Regulatory Compliance and Audit  • Pharmacy Benefits Management  • Clinical Pharmacy Programs  • Plan Performance and Quality Assurance  • Medicare Part B and D Prior Authorizations and Appeals  • Product Development  • Administration and Leadership  RESPONSIBILITIES/TASKS:  • Assist Senior Leadership in the planning, development, and implementation of Medicare Part D products, programs, and services such as submission of the CMS bid.  • Help to develop, implement and maintain utilization management and drug utilization review programs.  • Serve as a key clinical support person for processing drug information inquiries.  • Participate in the Pharmacy & Therapeutics committee, making both clinical and financial formulary...

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. 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 data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies. Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters. Develop lines of communication to discuss/review results of analysis to management via reports/presentations and...

Service Intelligence & Analytics (SIA) is a team within Service Operations who are responsible for advanced analytics in support of Customer Service, with a specific focus on customer and CSR experience as well as strategic business modeling. SIA works closely with the Service Avengers group, who are a group of leaders from various functional areas within Service Ops, whose charter is to discover opportunities for improvement in the member/provider experience, operational performance, and day-to-day CSR practices. This position will primarily be focused on working with SIA in the development (and potential implementation) of a project that will impact a process, system, function, product, and/or service after working closely with team members from throughout Service Operations to uncover opportunities.   As an intern, you will be:  Accountable for using analytics to develop a project(s) with moderate to complex scope and deliverables. Project scope may impact one or more...