33 operations analyst jobs found in Detroit

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...

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....

Why GM Financial Technology? Innovation isn’t just a talking point at GM Financial, it’s how we operate. From generative AI and cloud-native technologies to peer-led learning and hackathons, our tech teams are building real solutions that make a difference. We’re committed to AI-powered transformation, using advanced machine learning and automation to help us reimagine customer interactions and modernize operations, positioning GM Financial as a leader in digital innovation within a dynamic industry. Join us and discover a workplace where your ideas matter, your development is prioritized, and you can truly make a global impact. About The Role: This role is responsible for building the organizational capability to deliver effectively and predictably, with high-quality execution across the portfolio and alignment to the Product Operating Model. Through coaching, delivery insights, and continuous improvement, the role enables teams to increase flow, quality, and...

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....

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...

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...

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...

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...

The Instructional Designer is responsible for designing learning experiences that solve business problems through the thoughtful combination of communications, eLearning, instructor-led training, performance support and other interventions. They ensure that high-quality, innovative, and effective learning solutions are designed, developed, and delivered by different teams in a timely manner to satisfy business needs. Engage with stakeholders from different parts of the business to rapidly analyze their needs and design high-level learning solutions that may include a range of low, medium and high-fidelity learning interventions   Plan, coordinate, and develop support materials and communications for divisional and/or corporate projects.   Report project statuses to various levels of management.   Develop performance-based training and development systems to meet operational needs and requirements.   Develop cross-trainings for various employees to carry...

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....

SUMMARY:  The purpose of the Medicare Part D PGY1 residency program is to empower and educate the resident in all areas of Medicare Part D practice, including but not limited to:  • Formulary Management (including Rebates)  • Pharmacy and Regulatory Compliance and Audit  • Pharmacy Benefits Management  • Clinical Pharmacy Programs  • Plan Performance and Quality Assurance  • Medicare Part B and D Prior Authorizations and Appeals  • Product Development  • Administration and Leadership  RESPONSIBILITIES/TASKS:  • Assist Senior Leadership in the planning, development, and implementation of Medicare Part D products, programs, and services such as submission of the CMS bid.  • Help to develop, implement and maintain utilization management and drug utilization review programs.  • Serve as a key clinical support person for processing drug information inquiries.  • Participate in the Pharmacy & Therapeutics committee, making both clinical and financial formulary...

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 principles/methodologies. Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters. Develop lines of communication to discuss/review results of analysis to management via reports/presentations and...

Service Intelligence & Analytics (SIA) is a team within Service Operations who are responsible for advanced analytics in support of Customer Service, with a specific focus on customer and CSR experience as well as strategic business modeling. SIA works closely with the Service Avengers group, who are a group of leaders from various functional areas within Service Ops, whose charter is to discover opportunities for improvement in the member/provider experience, operational performance, and day-to-day CSR practices. This position will primarily be focused on working with SIA in the development (and potential implementation) of a project that will impact a process, system, function, product, and/or service after working closely with team members from throughout Service Operations to uncover opportunities.   As an intern, you will be:  Accountable for using analytics to develop a project(s) with moderate to complex scope and deliverables. Project scope may impact one or more...

This intern will support the MA core team with the day-to-day functions of managing the Business Partner servicing team and internal call center operations through reporting, data analysis, and project coordination. This role provides exposure to vendor management, performance metrics, and operations strategy. The intern will contribute to cross-functional initiatives, assist with educational materials, and support planning efforts for Business Partner site visits and internal events. Our intern will gain hands-on experience in business operations, learn how to develop and build professional relationships, develop analytical and communication skills, and build a strong foundation in vendor and call center operations.  As an intern, you will:  Pull and analyze daily reports and performance metrics.  Develop presentations and educational materials based on call center needs.  Support planning and execution of Business Partner meetings and site visits, as well as internal...

Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems, reporting and new products/programs to improve customer service levels and overall quality. Support the development, coordination, and implementation of projects to enhance the overall efficiency of operational procedures, methods, controls, and performance. Compile and analyze operational data to identify and resolve business problems. Utilize and maintain available reporting systems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process. Provide leadership team with status updates on projects and issues. Communicate and recommend policy changes to achieve project objectives. Assist in documenting departmental procedures. Create and present reports and presentations to display operational...