81 jobs found in Detroit

Provide clinical expertise across the enterprise for various functions.  Responsible for corporate and medical policy interpretation, recommendation, and review within recognized areas of responsibility.  Advise and collaborate in the development of clinical programs. Provide clinical support and participate in utilization management, quality management, and care management programs in respective area and identify opportunities for improvement and efficiency. Assist in the design, development, implementation and assessment of disease state management and health enhancement programs that support the appropriate use of clinical resources in the delivery of consistent high-quality medical care. Provide clinical leadership for health promotion and education programs and the claims editing department. Assist in establishing corporate and regional programs to enhance quality of care, reduce medical costs and achieve positive health outcomes. Serves as clinical...

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....

Provides clinical program leadership and develops, implements and approves policies within recognized area of responsibility. Develop and maintain medical policy.  Establish rationale for approving inquires and appeals.   Assists with clinical research, writing documents, and documenting decisions.   Provide utilization management for prior authorization procedures.  Review cases and make decisions based on medical policy.     Provide clinical support to various areas of the organization.  Process requests for clarification, interpretation, or questions about policy or benefits.  Review potential impacts of clinical matters.   Serves as clinical resource and subject matter expert to both clinical and non-clinical staff.   Perform clinical reviews and conduct peer to peers.   Participate in JUMP committee meetings.   " Qualifications " Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O) required.   Seven (7)...

This position supports attorneys in the Office of General Counsel (OGC). All tasks are performed under the supervision and direction of attorneys.  The tasks include, but are not limited to preparation of legal documents, legal research, compilation of records, review and summarizing of documents, timely regulatory, court and administrative filings, and communicating with internal and external stakeholders regarding legal matters impacting the organization. Assisting attorneys with the preparation of documents. Acting as liaison among all internal parties for scheduling and sharing information. Organizing and managing documents, including the creation of spreadsheets and presentations. Coordinating the collection, review, and production of documents. Researching factual issues using in-house files and outside reference sources. Compiling information and preparing statistics, charts, graphs, and other summaries to detail the findings. Working...

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 Customer Services 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...

Know your rights Inform yourself of your rights and responsibilities by reviewing the content provided in the list below. Employment Eligibility (e-Verify):  English & Spanish Right to work:  English  /  Spanish It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Position Overview :  The primary duties of a field adjuster are to inspect the loss and prepare documents detailing the claim. Essential Job Functions Communicate with desk examiners, insureds, attorneys, and other experts to gather information on claims Negotiate settlements with the insured and/or their representatives Prepare reports based on the policy language and submit payment recommendations to the desk examiners Prepare detailed estimates of the damage Manage workload and submit closing documents in a timely fashion Regular and reliable attendance Marginal Job...

Our Company: Established in 2012, Seek Now captures robust property data to meet the needs of customers across the insurance and real estate industries. With more than 2 million property inspections completed to date while currently servicing 3,000 properties per day, Seek Now is the leading data capture and inspection services firm serving 240+ customers. Our mission is to help our customers make faster decisions and improve economic outcomes, all while providing a stellar customer experience. We accomplish this through continuously reimagining how information is captured, transformed, and transmitted across all the industries we serve. Our vision is to be the leading provider of on-demand, ground truth property data solutions. We do this while creating individual growth opportunities for our employees, expanding network of Seekers, and value add partners. Summary: Seek Now is searching for capable 1099 independent sub-contractors to provide accurate,...

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...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for creating or auditing a comprehensive estimate of damages for 1st and 3rd party material damage claims in either the auto or specialty lines leading to the proper disposition. Responsible for training, mentoring, controlling quality and providing technical assistance on material damage claims. This is a field adjuster position in Wayne County, Michigan. Candidates should be local and able to travel within the Detroit, Michigan area. Key Responsibilities • Possesses strong estimating fundamentals in order to create or audit estimates of damages on 1st and 3rd party material...

Why GM Financial Technology? GM Financial is set to change the auto finance industry and is leading the path with embarking on tech modernization – we have a startup mindset, preserve our small company culture, in a public company environment with financial stability and intense growth over a decade long history. We are data junkies and trust in data and insights to advance our business objectives.  We take our goal of zero emission, zero collision, zero congestion and zero friction very seriously. We believe as the auto finance market leader we are in the driver seat to lead us in the GM EV mission to change the world. We are building global platforms, LATAM, Europe, China – our high performing talent needs a high performing leader. GMF is comprised of over 10,000 team members globally. Join our fin-tech culture within a Blue-Chip company where we are changing the way we use technology to support our customer and business.   About the Role: The VP, Servicing...

Responsible for sales activities in an assigned territory/geographical areas of more than 1,000 accounts, which may include national accounts or associations.  Accountable for implementing a prospecting process identifying sales potential, linking products to the account’s business goals, qualifying and enrolling group clients and coordinating the servicing of these clients.  Manage quality and consistency of product and service delivery. Identify potential group account customers through prospecting and qualifying program methodology, agent contacts and maintain comprehensive database of all prospects. Determine the account decision making process and key union/management stakeholder roles to support the development of sales strategies and the acquisition of group account business. Prepare a variety of sales reports, action plans, presentations, proposals, sales contracts and schedules. Identify and follow up new leads and referrals obtained from field activity; project the...

SHS MA Group Medicare Sales Planning and Execution The Communications Specialist is responsible for supporting the development, promotion, and growth of communications initiatives internally within the division and across business units. Also responsible for developing key messages and strategic communications to be communicated to the parent company. This position will lead various initiatives requiring strategic planning through tactical execution. Responsible for key internal communications activities and projects to support the company's business objectives. The specialist will be a critical member of the communications team and will interface with executive management. Lead development and execution of division communication initiatives. Coordinate executive leadership communications and events. Employee intranet content development. Serve as consultative subject matter expert for internal stakeholders and communications representative on...

Department Preferences Finance Major preferred   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,...

The Analyst Trainee is part of an Advance Hire Analyst Training Program, in which trainees receive real-world hands-on experience, with the goal of career advancement within 12-24 months. Support issue resolution, manage projects, prepare reports, and analyze data using project management and Agile principles. Communicate effectively with internal and external partners and formally present information to stakeholders. Foster problem resolution, critical thinking, and leadership skills. Develop strategic problem-solving, quantitative analytics, and communication skills through use of information, data, analytics, ingenuity, and empathy in innovative ways to deliver technology-driven solutions. Effectively support projects and teams to produce desired results. Develop and improve departmental workflows, business processes, and standard policies for routine services. Produce routine and non-routine reports, presentations, letters, communications, and graphics. Foster problem...

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...

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...

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...

This position is accountable to establish and maintain effective lines of communication and build effective working relationships with key union leadership that purchase and/or influence the purchase of group health insurance, which will enhance BCBSM ability to penetrate, retain and upgrade groups within our markets. Establish and maintain effective communication and working relationships with top level leadership of major unions and their staffs that purchase and/or influence the purchase of group health care insurance.   Establish self as a resource on group health insurance, which will encourage union leaders to seek advice and counsel.   Gather information on potential groups, assess the situation and provide this information to the appropriate corporate marketing representative followed by consultative support on strategy and problem resolution.   Respond to requests for advice and/or information on group health insurance needed by top level leadership of major...