48 management jobs found in Detroit, MI

Responsible for the completion of assignments for the coordination of the Quality Management Program through problem identification, development and coordination of QM studies, investigation of quality-related member and practitioner inquiries, and plan compliance with state and federal regulations and accrediting bodies.  Measures and analyzes results of QI activities, recommends interventions, and conducts follow-up. Collaborates with Care Management, Customer Services, Provider Affairs, and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner, and provider quality related issues. Works with plan Medical Director on development and revision of Clinical Practice Guidelines.  Assists management with the revision of Quality Management policies. Develops, maintains, and enhances reporting methods to identify trends in physician and member behavior.  Completes applicable...

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...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Field Case Manager This Feidl Case Manager will cover our Detroit, MI region and must live in this area in order to be considered. PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers t o facilitate; through advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties. While frequent travel is...

Description Summary: The Commercial Relationship Manager I is responsible for building and servicing a sound and profitable portfolio of commercial business relationships and loans, and satisfying and exceeding customer needs and expectations as well as credit and regulatory requirements for originating and structuring Commercial loans. Originate, monitor and renew loan relationships consistent with the bank’s policies and procedures. Serves as the point person in determining the customer's needs and meeting them through the seamless delivery of the bank's products, services and associated resources.  Duties and Responsibilities: Originate, analyze, structure and close profitable loan transactions. Participate with more senior Relationship Managers on larger loans and stay informed regarding the status of loans in the department. Maintain and confirm credit worthiness of customers. Gather, review and...

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...

The Release Train Engineer (RTE) is the servant leader and coach for an Agile Release Train (ART), enabling cross-functional teams to effectively plan, execute, and continuously improve the delivery of business value. The RTE partners with Product Management, Product Owners, Scrum Masters, Business Owners, System Architects, and Agile Teams to foster alignment, remove impediments, and improve flow across the ART. This role champions the foundational principles and values of the Scaled Agile Framework (SAFe), promoting a culture of collaboration, transparency, continuous learning, and servant leadership. While primarily focused on the flow and effectiveness of the Agile Release Train, the RTE also partners with Enterprise Agile leadership to advance Lean-Agile practices and contribute to the organization's broader delivery of value. Experienced Lean-Agile leader who enables high-performing teams through influence rather than authority. Excel at facilitating alignment towards...

Employer: Blue Cross Blue Shield of Michigan Job Title: Application Developer III Job Location: 600 E Lafayette Blvd, Detroit, MI 48226 Job Type: Full-time, 40 hours a week, Monday  –  Friday Duties: Code applications or enterprise wide software systems using a disciplined development process. Integrate solutions with other applications and platforms outside the framework. Create data extracts and reports from system based on requirements. Support and/or execute all testing efforts across the life cycle. Create technical design specifications and assist in sizing technical requirements, as needed. Lead the deployment of new modules upgrades and fixes to the production environment, as needed. Make modules production-ready by moving them to libraries, completing forms and version control documents, following procedures, etc. Evaluate new application packages and tools and performs research on best practices. Provide recommendations for solutions. Troubleshoot...

Join Blue Cross Blue Shield of Michigan as a Senior Financial Analyst- Financial Reporting and help support accurate, timely, and well-informed financial reporting that drives business decisions and regulatory compliance. In this role, you’ll contribute to statutory and GAAP financial reporting, regulatory deliverables, audit support, account reconciliations and variance analysis while collaborating with finance partners, leadership, auditors, and key stakeholders. This is an opportunity to apply your financial expertise, attention to detail, and analytical mindset in a role that supports the integrity of critical financial information across the organization. Prepares financial information and reviews for accuracy and completeness.  Performs detailed analysis when necessary. Other deliverables may include account reconciliations, impact studies, audit findings, budgets and business cases.  Assists with the preparation of various financial or regulatory reports and/or...

SUMMARY     T The Manager, Stars Data & Analytics will oversee activities in support of Stars data management including Stars projection generation, oversight of the Stars vendor performance, collaboration with IT teams, and reporting. This position is responsible to plan, organize, direct, control, and lead the assigned business unit.  ESSENTIAL DUTIES AND RESPONSIBILITIES:  • Manages activities of a department including, but not limited to, planning, problem solving, staff development, and communication.  • Executes function/area objectives that support continuous improvement.  • Manages professional, exempt, and non-exempt non-bargaining and bargaining unit employees.  • Responsible for special projects and/or problem resolutions.  • Provides effective and efficient solutions to complex business problems.  • Provides high level oversight and leadership.  • Participates in development of annual departmental budget, monitors budget, and identifies budget...

Join Blue Cross Blue Shield of Michigan as a Financial Coordinator and play a key role in driving financial insights that support strategic business decisions. In this role, you will analyze and report on financial performance, including revenues, expenses, trends, and program profitability across business segments. You will also develop financial models and analyses that help guide future business initiatives. Working independently and collaboratively on cross-functional projects, you'll contribute to meaningful financial outcomes while managing multiple priorities in a fast-paced environment. DEPARTMENTAL PREFERENCES: Healthcare, insurance, or similarly regulated accounting and financial reporting experience preferred. Experience preparing or reviewing journal entries, account reconciliations, financial statements, regulatory reports, close activities, and financial analysis related to premiums, claims, provider payments, fixed assets, administrative expenses,...

The next part of your journey is right around the corner — with The Standard. A genuine desire to make a difference in the lives of others is the foundation for everything we do. With a customer-first mindset and an intentional focus on building strong teams, we’ve been able to uphold our legacy of financial stability while investing in new, innovative technologies that support the needs of our customers. Our high-performance culture focused on operational excellence thrives thanks to remarkable people united by compassion and a customer-first commitment. Are you ready to make a difference? As a Sales Analyst on the Employee Benefits team, you will manage the RFP (proposal) process for new business as well as existing/growing business through your blend of relationship management, customer service, and analytical skills. In addition to RFP management, your ability to build and maintain meaningful, effective relationships will be vital as you collaborate with internal...

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments. Review, research and authorize requests for authorization of elective, direct, ancillary, urgent, emergency, etc. services. Contact appropriate medical and support personnel to identify and recommend alternative treatment, service levels, length of stays, etc. using approved clinical protocols. Analyze, research, respond to and prepare documentation related to retrospective review requests and appeals in accordance with local, state and federal regulatory and designated accreditation (e.g. NCQA) standards.  Establish, coordinate and communicate discharge planning needs with...

Departmental Summary This role is responsible for leading day-to-day IT delivery activities for the Epic implementation project, including planning, execution, dependency management, risk and issue tracking, delivery status reporting, and coordination across business, IT, Epic, vendor, and implementation partner teams. The IT Delivery Lead will partner closely with the Delivery Manager, Product Owner, Business Leads, Technical Leads, Architects, Business Analysts, Testing, Infrastructure, Security, Informatics, and other workstream teams to ensure scope, schedule, budget, quality, governance, and implementation readiness remain aligned throughout the project lifecycle. Preference is for a candidate with demonstrated experience leading large, complex programs or projects that span multiple teams, departments, workstreams, and stakeholder groups. Departmental Requirements Candidates must have proven experience managing complex IT delivery efforts, preferably within...

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. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a Sr. Auto Appraiser – Field, within defined guidelines and framework, will be responsible for the investigation, negotiation, evaluation and appraisal of vehicle damage claims for both repairable and total loss vehicles to ensure estimate accuracy in compliance with state laws and regulations. Accountable for delivering...

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...

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)...

Description Summary: The Business Analyst 3 provides advanced support for assigned business process and/or system within a business unit. Duties & Responsibilities: Maintains, monitors, updates assigned business process and/or system. Researches complex problems and acts independently to resolve. Analyzes existing business process and or systems and determines technical or procedural improvements and implements changes. Develops and provides documentation for users and training purposes. Develops operational procedures for products, services and systems supported.  Designs processes to meet regulatory requirements. Develops and generates specialized and ad hoc reports. Analyzes reports and makes recommendations for improvements in processes and /or systems.  Provides technical support to business unit, customers, management and other users.  Acts as liaison between software vendors and...

Description Summary: The Commercial Relationship Mgr III is responsible for building and servicing a sound and profitable portfolio of commercial business relationships and loans, and satisfying and exceeding customer needs and expectations, as well as credit and regulatory requirements, for originating and structuring Commercial loans. Originate, monitor and renew loan relationships consistent with the bank’s policies and procedures. Serves as the point person in determining the customer's needs and meeting them through the seamless delivery of the bank's products, services and associated resources.  Will be assigned a minimum sales goal of $100MM and a minimum portfolio of $60MM in commitments.  Works with the most sophisticated customers and on the  most complex deal structures.  Can mentor more junior Relationship Managers. Duties & Responsibilities: Originate, analyze, structure and close profitable...

Description Summary: The Credit Review Team Leader Sr. will report directly to the Credit Review Director or Credit Review Group Manager. This role involves leading a team in various credit risk review engagements and continuous monitoring activities associated with a strong independent credit review and/or similar credit risk management function. The Credit Review Team Leader Sr. has a proven track record in a Credit Review management role or similar leadership position and has demonstrated exceptional delivery results within a demanding environment. Duties and Responsibilities: Serve as the departmental subject matter expert in credit risk in one of more of the segments within the commercial and/or consumer portfolios and have general knowledge of lending support area practices impact on credit risk within the financial services industry. Develop and maintain working relationships with executive bank...