Emergent Holdings · 1 day ago
Analyst - Senior - Payment Integrity Unit
Detroit, MI
Full-time
Onsite
Mid, Senior Level
4+ years expEmergent Holdings is seeking a Senior Analyst for their Payment Integrity Unit, responsible for leading the development and implementation of programs and strategies to enhance business decision-making capabilities. The role involves analyzing operational data, improving workflows, and ensuring compliance while providing support and training to internal and external stakeholders.
Health CareInformation ServicesInformation TechnologyInsuranceMedical
Responsibilities
Identify and analyze operational data and develop insights in support of business objectives
Develop and improve work flows and business processes within defined areas to improve customer service, decrease operational costs and improve overall quality
Identify and/or analyze business problems and develop recommendations for solutions to problems
Lead the development and implementation of projects and/or teams in order to produce desired results
Document and communicate project concepts, milestones and results
Recommend and assist with implementing standard policies and procedures
Ensure that corporate compliance is communicated, implemented and monitored on an ongoing basis
Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process
Provide support to internal departments and external entities by answering questions, supplying information and training
Create and present reports and presentations to display operational data and proposed business changes
Qualification
Required
Four (4) years of experience in a related field is required
Excellent 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 lead multiple activities with varying timelines
Excellent verbal, written communication and interpersonal skills
Ability to lead and contribute to business unit and/or corporate projects
Proficient in Microsoft Office Suites
Ability to develop and maintain effective working relationships
Preferred
Bachelor's Degree in a related field is preferred
Possess a comprehensive understanding and knowledge of the basic tenets of health insurance, the managed care model, Medicare Advantage (Facility and Professional lines of services), Coordination of Benefits, Provider Audit, Medicare/CMS & Medicaid rules, claim adjudication process including clinical and medical billing and coding procedures and reimbursement practices
Payment integrity systems knowledge preferred
Knowledge of CMS and/or Blue Cross Blue Shield Association guidelines and regulation preferred
Excellent analytical, decision making, organizational, planning, creative problem solving, and ability to work with minimal direction
Excellent verbal and written communication/presentation skills
Working knowledge of: Microsoft Outlook, Microsoft Word/Excel/Power Point/Access/SQL
Company
Emergent Holdings
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John S. Roberts
Executive Vice President, Emerging Markets & Chief Administrative Officer
Brittanie Benson
Human Resources Business Partner
Recent News
Thailand Business News
2025-06-21
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