5 claims operations technician jobs found in Detroit

This role is responsible for designing, optimizing, and governing the conversational content and prompt architecture that powers AI-enabled member self-service. The role translates complex healthcare, insurance, benefits, and operational terminology into clear member language and influences model behavior through grounded prompt design, conversational examples, testing, feedback, monitoring, and continuous refinement. This role will also partner with Product Management, Product Owners, design, engineering, data and AI teams, member experience, operations, legal, compliance, privacy, clinical, and business subject-matter experts to ensure conversations are understandable, accurate, trusted, accessible, and aligned to product outcomes and organizational standards. Lead conversational content and prompt strategy for AI-enabled member self-service. Define member-friendly wording, conversational tone, response length, response structure, progressive disclosure, follow-up patterns,...

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,...

                                                                   Moderate travel, including nationwide travel, is required (up to 50%) Department Summary Serve as a subject matter expert for UAW Trust benefits, claims, and member advocacy. Possess NASCO claims processing knowledge and experience. Demonstrate strong understanding of MAPPO, Medicare Advantage, Commercial, HMO, and PPO benefit structures and claim processing differences. Investigate and resolve complex claims issues, benefit processing concerns, and member escalations. Support member meetings and travel team activities, including direct member interactions and issue resolution. Attend and actively participate in internal and external workgroup meetings representing the Trust account. Coordinate, submit, and oversee benefit implementation requests and ensure implementations are accurately configured and tested. Partner with operational, benefit, provider, and claims teams to identify and...

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....

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....