12 senior health care 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...

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 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...

The Expert Analyst is responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions.  This role also coordinates projects for senior management. Develops documentation, reports and presentations for all levels within the organization including executive leadership. Demonstrates ownership of assigned analyses from data pull through validation, summary of findings, and final deliverable. Summarizes analytical findings clearly, including approach, key observations, conclusions, and business implications. Performs data validation and quality checks to ensure accuracy, completeness, and consistency of reporting outputs. Responsible for trend analysis, report development, ad-hoc analysis and support Develop and present complex analytics concisely for consumption by upper management and Executive leadership Conduct healthcare analytics to evaluate quality performance, member outcomes,...

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...

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...

Employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity. We will only consider candidates who are currently authorized to work in the United States and who will not require sponsorship now or in the future. Please note: student visas, CPT, OPT, H-1B, TN, and other temporary work authorizations are considered restricted forms of employment eligibility. Once these expire, the candidate must be able to present another valid form of work authorization.   Contract Dates: June 2027 through August 2027 Other hiring locations for this role are: Boston, MA; New York, NY; Atlanta, GA; San Francisco, CA; Houston, TX; Dallas, TX We are in the business of transforming tomorrows. Join us and transform yours.   The Business   Create your future. In Health & Benefits (H&B), our purpose is that through our colleagues we help our clients make a difference in the lives of their employees. We help large and mid-size...

This position is responsible for planning, organizing, and monitoring the audit coordination processes for the OGACC - Office of the General Auditor & Corporate Compliance – Emerging Markets (OGACC – EM). This position interacts routinely with the Company executives, directors, and managers, as well as BCBSM. This role requires exercising discretion and judgment in assisting the general auditor and internal audit staff. Discretion and judgment are also required when communicating with executives and staff throughout the enterprise and BCBSM. This position performs executive support tasks which may be highly confidential and sensitive in nature utilizing considerable independent judgment. Performing high-level administrative work, including organizing, scheduling, coordinating, researching, compiling, exchanging, and sometimes analyzing information for executive(s) and the department is also required. Leads on-site audit activities between OGACC - EM and the enterprise....

This intern will support the MA core team with the day-to-day functions of managing the Business Partner servicing team and internal call center operations through reporting, data analysis, and project coordination. This role provides exposure to vendor management, performance metrics, and operations strategy. The intern will contribute to cross-functional initiatives, assist with educational materials, and support planning efforts for Business Partner site visits and internal events. Our intern will gain hands-on experience in business operations, learn how to develop and build professional relationships, develop analytical and communication skills, and build a strong foundation in vendor and call center operations.  As an intern, you will:  Pull and analyze daily reports and performance metrics.  Develop presentations and educational materials based on call center needs.  Support planning and execution of Business Partner meetings and site visits, as well as internal...

**Requires travel throughout the state   Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions.  Coordinate projects for senior management. Research, analyze, identify, and evaluate data from assigned problems to evaluate existing and potential trends and issues. Possess and maintain a comprehensive understanding and knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies. Assist in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters. Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions. Recommend, communicate, and implement solutions to...

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...