14 field case manager jobs found in Detroit, MI

SUMMARY    Responsible to plan, organize, direct, , and lead market research activities within the Medicare Strategy and Performance business unit; Use qualitative and quantitative methods to derive data and insights that support strategy, planning and performance activities.  The ideal candidate for this department will:  Be a strategic thinker with deep business and industry knowledge of government programs.   Use data and visualization tools to drive insights to support strategy.  Possess a willingness to learn in complex industry and adaptive landscape.    ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.  1. Support activities that are directly related to the development, design, and administration of methods and procedures, including surveys, to assess consumer preferences, the health care environment and the competitive landscape.  2. Interpret and predict trends derived from the collection, study, and...

Departmental Summary Accountable for leading enterprise digital and automation initiatives from strategy through sustained execution. Owns multi‑year transformation efforts with complex scope that span processes, systems, and business functions. Delivers solutions that modernize how work gets done, reduce manual effort, and improve scale and consistency across the enterprise. Partners closely with business and technology leaders to align work to enterprise priorities and measurable outcomes. Monitor progress and produce project status reports, timelines, budget reports, and project metrics, including delivery, adoption, and automation outcomes. Plan projects, including concept, design, planning, project scope, cost and benefits, testing, acceptance, implementation, and post‑implementation review of digital, automation, and process transformation deliverables. Lead cross‑functional teams comprised of internal business partners, technology teams, and vendor resources....

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Property Adjuster Specialist , you will work within established guidelines and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes coverage, recognize liability exposure and negotiate equitable settlements in compliance with all state regulatory requirements. Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling....

SUMMARY:    The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments.  This position operates within broad objectives to ensure optimum utilization of manpower and budget.  This role researches, compiles, and analyzes appropriate and relevant data and makes recommendations for operational improvements.  RESPONSIBILITIES/TASKS:  Support PBM transition tasks and participate in workstream meetings Supports PBM audit and analytics to support Medicare pharmacy services business team.  Builds and supports business reports to be included in executive dashboard. Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues. Possesses and maintains an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional...

The Client Relations Compliance Consultant leverages CMS compliance and business needs.  This role assists with Compliance operations and performance and interfaces directly with clients, serving as the primary contact for issues and requests generated by the client.  The Client Relations Compliance Consultant is accountable for key measures and performance indicators, as well as communications with appropriate business owners to resolve issues. Creates and manages user accounts in a variety of systems, including Medicare Advantage Systems, in compliance with internal policies and system access protocols. Maintains Role-Based Access Matrices. Reviews and submits collateral and communications to CMS for approval. Facilitates communication between customers and internal constituents regarding regulatory activities and changes. Collaborates with peers to understand impact of compliance/non-compliance for products and customers. Assists peers with the identification and...

Departmental Preferences: Intermediate ability to identify, evaluate, and integrate generative AI tools (e.g., AI coding assistants, chat-based models) into team workflows to enhance software development, analytics, documentation, and overall productivity, while maintaining code quality, security, and adherence to engineering best practices Demonstrated experience establishing and enforcing team-level generative AI guidelines, including coaching staff on responsible use, ensuring all AI‑generated code and content is thoroughly reviewed, validated, and understood before adoption, and maintaining compliance with corporate GenAI and data governance policies   Responsible for solving highly complex business cases by understanding problem statements and conditions to generate workable hypotheses and solve by creating data driven models. Leads data discovery and analyses, integrates and prepares large and varied datasets, and builds specialized databases and computing...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description A day in the life of a Large Loss Field Property Adjuster, and what it takes to do the job! As a Large Loss Field Property Adjuster, you will be dedicated to providing exceptional service to our policyholders. Your primary responsibility will involve traveling to our customers' homes to conduct on-site inspections, investigate coverage, prepare estimates, and settle claims promptly and efficiently. Additionally, you will handle virtual claims countrywide, leveraging various platforms and software such as Xactimate and ClaimsX...

Shift – 8:30am-5:00pm M-F; shift bidding process based on seniority. Site/Location: Detroit, MI Status – Regular Full Time       Provide thorough analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner ensuring provider, hospital/facility, Primary Care Group (PCG), and member quality customer service. Provide information and assistance pertaining to the Medical Management program to providers, hospitals, PCGs and members. Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. Collect and record appropriate data to issue authorization and route request for services that require medical review to appropriate team member(s).  Facilitate communication with providers regarding status on authorizations and referrals. Identify relevant issues and route to appropriate department for action and resolution....

SUMMARY:  This position is responsible for the Medication Adherence program for BCBSM senior members. The Director will design and execute a multi-year strategy that improves adherence rates and achieves Star measure performance goals. The Director will report to the Managing Director of Pharmacy Quality and oversee a large, multidisciplinary team of pharmacists, pharmacy technicians, data analysts, and external vendors. This role requires strong cross‑functional collaboration with clinical, operations, IT, finance, and external partners to integrate adherence initiatives, drive performance, and apply emerging digital tools and analytics to scale impact. The ideal candidate combines deep pharmacy expertise with proven leadership, strategic thinking, change-management skills and the ability to influence stakeholders at all levels. RESPONSIBILITIES/TASKS: • Serves as the department lead and subject-matter expert for CMS Star Medication Adherence measure performance; interpret...

Conduct compliance investigations and lead the execution of moderately complex initiatives for Blue Cross Blue Shield of Michigan (BCBSM) and its subsidiaries. Analyze and develop documentation to support regulatory changes and departmental policies and procedures. Conduct comprehensive and moderately complex regulatory analyses to include the review, summarization and dissemination of compliance reports. Provide support and recommendations for privacy investigations to mitigate business risk. Develop work flows to define the documentation of department processes, report generation, and process improvements. Define assigned project scope and deliverables to support compliance initiatives. Partner with the business to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics and processes. Promote compliance awareness by supporting training, programs and departmental activities. Provide support or lead government audit...

About Auris   Auris is the payroll and HR partner built for small and medium-sized business who can’t afford to get it wrong. Trusted by over 50,000 business nationwide, Auris pairs easy-to-use technology with real human services to give leaders the confidence that every detail is done right - so they can focus on growing their team and their business. Acquired by Acrisure in 2025, Auris formerly Heartland Payroll is accelerating its vision to deliver seamless human-centered technology to help small businesses thrive.     Job Summary   Responsible for prospecting and running Auris Payroll presentations both in person and over the phone to small and mid-sized merchants and businesses to ultimately close deals within a fast sales cycle. As a Payroll Territory Manager (PTM) , you will report to the Payroll Division Manager (PDM) .  Activities include explaining our value proposition to clients via Atlas CRM,...

Responsible to identify, prioritize and develop strategies to support Blue Cross Blue Shield of Michigan’s (BCBSM) competitive position, achieve positive business results, and improve the health and wellbeing of our members.  Responsible to make recommendations on consequential matters with long-term implications for the organization, including: setting enterprise aspirations and targets, developing enterprise-level strategies, assessing strategic investments and partnerships, and evaluating the enterprise’s overall portfolio of assets. Oversee or perform analyses including, but not limited to, financial modeling, claims analyses and complex statistical analyses.   Manage activities that are directly related to the corporate strategies, goals and objectives.     Utilize primary and secondary research to assist in identifying best practices and opportunities for the corporation.   Create executive level PowerPoint presentations and correspondence to...

The Director, Government Programs- Data & Engineering drives the execution of data use and adoption for Government Programs and CFO areas. This role promotes the use of AI, automation, and best-in-class technology across teams; will partner with business, technology, product, and operations leadership to lead the delivery of business imperatives. The Director will ensure access to accurate and high-quality data and provide support for reporting, analytics, and modeling across finance, controller, actuarial, UW, and Government Programs. The role leads the design of member level constructs across CFO, Commercial, MA, JVs. The Director also supports working with IT and ensuring migration of off legacy analytics systems (CADE/IDAP) as well as support for reporting and visualization creation working with business partners. Drive coordination with enterprise stakeholders (e.g., IT, ACoE) alongside the Actuarial, Finance, Underwriting, and Government Programs Planning...

Department Preferences Technical Experience Minimum 3 years SQL experience required Minimum 1 year python experience preferred 1 year Databricks preferred Data analysis experience 3 years healthcare experience required Risk Adjustment experience preferred   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...