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Blue Cross Blue Shield of Michigan · 1 day ago

Manager - Payment Integrity Operations

441 E Jefferson Ave, Detroit, MI, 48226, US

Full-time

Onsite

Mid, Senior Level

5+ years exp

Blue Cross Blue Shield of Michigan is seeking a Manager for Payment Integrity Operations to oversee an assigned business unit. The role involves planning, organizing, and managing departmental activities while ensuring alignment with organizational objectives and continuous improvement in business processes.

Health CareHealth Insurance

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Manage activities of a department including, but not limited to planning, problem solving, staff development and communication

Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement

Lead, direct, evaluate and develop the work of assigned employees

Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes

Provide effective and efficient solutions to complex business problems

Ensure that day to day business unit operations align with organizational objectives

Qualification

Healthcare claims knowledgeProject managementTeam leadershipAnalytical skillsProblem-solving skillsCommunication skillsCoaching skillsOrganizational skillsInterpersonal skillsCollaboration skills

Required

Bachelor's Degree in a related field is required

Five (5) years of experience in a related field is required

Previous experience leading projects and/or teams is required

Ability to effectively lead, coach and develop team members

Ability to work effectively in a team environment

Strong organizational, planning, analytical, and problem-solving skills

Working knowledge of corporate organizational structures, including functional responsibilities

Strong verbal, written communication and interpersonal skills

Ability to manage multiple priorities concurrently

Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment

Ability to interface and present to all levels of the organization

Ability to build relationships and work collaboratively with cross-functional teams

Preferred

Master's Degree in a related field is preferred

Five (5) years related work experience in all lines of business: Commercial PPO, HMO and Medicare product related work experience within a healthcare organization or equivalent combination of transferable experience and education

Seven (7) years Claim platform experience in Nasco-NPS, Facets and ika

Demonstrated knowledge and application of Inter-Plan claims processing, payment integrity and overall policies/procedures

Extensive working knowledge and demonstrated subject matter expertise in the areas of Federal, State and BCBSA regulatory mandates and compliance programs

Ability to utilize functional and industry knowledge to efficiently and independently identify and build solutions for complex enterprise and product strategy issues related to Payment Integrity and Claims

Strong problem-solving and analytical skills as well as strong business acumen of healthcare claims with an emphasis on Payment Integrity

Company

Blue Cross Blue Shield of Michigan

Glassdoor3.9

We commit to being our members’ trusted partner by providing affordable, innovative products that improve their care and health.

Founded in 1929

Detroit, Michigan, USA

5001-10000 employees

http://www.bcbsm.com/

H1B Sponsorship

Blue Cross Blue Shield of Michigan has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (66)

2024 (49)

2023 (38)

2022 (58)

2021 (74)

2020 (60)