Analyst - Payment Integrity Unit

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 data and propose business changes.
• Provide support to both internal departments and external entities by answering questions, supplying information and training.
• Participate on special projects or workgroups as assigned.

"Qualifications"

• Bachelor's Degree in a related field is preferred.
• Two (2) years of experience in a related field is required.
• Effective verbal, written communication and interpersonal skills.
• Ability to work independently or in a team environment and interact with all levels of the organization.
• Effective analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.
• Organizational skills and ability to prioritize; must be able to coordinate multiple activities with varying timelines.
• Proficient in Microsoft Office suites.
• Ability to develop and maintain effective working relationships.

Departmental Preferences:

• Knowledge of BCBSM and/or Blue Cross Blue Shield Association guidelines and regulation knowledge is
  preferred.
• Payment integrity systems knowledge is preferred. 
• Experience with data analytics (SQL, MS Access, Web Portals), reporting and inventory management is preferred.
• Artificial Intelligence (AI): Experience with AI technologies, with a focus on applications in IT and Healthcare IT.
  • A foundation in AI concepts and techniques. Experience of applying AI to solve real-world problems in IT, such as predictive maintenance, anomaly detection that improve healthcare outcomes, and reduce costs is preferred.
• Experience in NASCO 3270 is preferred.
• Macro Development: Ability to design, develop, and implement new macros to automate tasks and improve processes is preferred.
• Process Improvements: Proven experience in analyzing and improving business processes, with a focus on efficiency, productivity, and quality is preferred.

• Data Visualization: Experience with data visualization tools, including:

  • Tableau: Knowledge of Tableau's data visualization and business intelligence capabilities, including creating interactive dashboards and stories is preferred.
  • Power BI: Familiarity with Power BI's data visualization and business analytics features, including creating reports, dashboards, and datasets is preferred.