Responsible for supporting the National Networks and Programs department functions. Operate within broad objectives to ensure that processes related to supporting customers and members with BCBSM coverage, but are receiving care out of state. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Research, analyze, identify, and evaluate data from assigned problems to evaluate existing and potential trends and issues.
2. Possess and maintain a comprehensive understanding and knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
3. Supporting National Networks and Programs by supporting alternative network assessments for Blue High Performance and Blue Select Networks.
4. Supporting National Networks and Programs by assisting with the management of the national network alert process. Management of this process involves monitoring and retrieving BCBSA Network Alerts from the Network Alert Portal, updating appropriate SharePoint notification logs, generating utilization reports in Databricks (existing queries), communicating the alert and reports to the appropriate BCBSM teams
5. Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
6. Supporting incoming and outgoing inquiries regarding member claims/coverage questions
7. Conducting fact finding missions around various health plans and markets using Blue Web / the Consortium Health Plan Market Navigator website and other means.
8. Other duties as assigned.

"Qualifications"

• Bachelor's Degree in Business Administration, Economics, Health Care, Information Systems, Statistics or other related field is required. Master's Degree in related field preferred.
• Four (4) or more years of experience in related field required.
• Strong communication skills are required to understand, interpret, and communicate ideas.
• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc).
• Working knowledge of data languages such as SAS or SQL / Databricks.
• Strong analytical, organizational, planning and problem solving skills.
• Ability to effectively interface with BCBSM employees at all levels, employees at other Blues plans, and group customers as well.
• Understand and apply statistical inference.
• Other related skills and/or abilities may be required to perform this job.

Department Information

• This role will be supporting National Networks and Programs by supporting alternative network assessments for Blue High Performance Network and Blue Select Networks, including creation and delivery of presentations to customers and other stakeholders.
• Working knowledge of data languages of SQL / Databricks strongly preferred

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.