17 claims 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...

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....

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...

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....

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....

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...

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. Now offering a $2500 sign on bonus to qualified candidates! Key Responsibilities: Reviewing assigned claims...

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...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Detroit, Michigan Chicago, Illinois Minneapolis, Minnesota Travel within the assigned local market is required, approximately 10% of the time, with no overnight travel and company vehicle provided. Position Schedule / Shift: Hybrid– Field schedule Monday – Friday: 8:30 AM EST – 5:30 PM EST. Position Summary: As a Field Property Claims Specialist, you'll conduct on-site property inspections, assess damages, determine coverage, prepare estimates, and guide policyholders through the claims process with professionalism and empathy. This role combines property claims expertise, customer service, and problem-solving to deliver timely, accurate claim resolutions while helping customers recover from unexpected losses. You'll also have opportunities to support catastrophe (CAT) response efforts, assisting customers and communities impacted by large-scale...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager! This professional will be primarily responsible for business development efforts and brand strategy within the states of Michigan, Ohio, Indiana, Western Pennsylvania, and Kentucky. This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall customer experience.  Frequent travel within a specified...

*Please note: previous insurance experience is required* WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager!  This professional will be primarily responsible for business development efforts and brand strategy within the states of Michigan, Ohio, Indiana, Western Pennsylvania, and Kentucky. This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager in Michigan!  This individual will be responsible for business development efforts and brand strategy within a specified territory.  This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall customer experience.  Frequent travel within a specified territory required.   Must be legally authorized to work...

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. Now offering a $2,500 Sign-On Bonus for qualified candidates Key Responsibilities: Reviewing assigned claims...

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. Now offering a $2500 sign on bonus to qualified candidates! Key Responsibilities: Reviewing assigned claims...