MA System Liaison Analyst — Claims & Process Improvement

Blue Cross Blue Shield of Michigan; Detroit (MI); On-site; USD 70,000 - 105,000; Full time

Job summary

Blue Cross Blue Shield of Michigan seeks a data-and-process professional to identify operational insights and develop workflows that improve customer service and reduce costs. You will lead projects, communicate milestones, and ensure compliance across departments.

Responsibilities include designing Medicare Advantage claims logic, configuring benefits, analyzing claims data, and producing reports for stakeholders. Strong analytical and communication skills are essential for success.

Qualifications

• Four 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.

Responsibilities

• Design, develop, and implement new system claims logic for Medicare Advantage (MA) products.
• Configure MA benefit parameters within the claims processing platform, ensuring alignment with CMS guidelines.
• Perform detailed examinations of MA claims to verify accuracy, compliance, and proper reimbursement.
• Identify, document, and resolve defects in the claims processing system, collaborating with IT and NASCO, and vendor teams as needed.
• Stay current with CMS regulations, MA policy updates, and industry best practices related to claims processing.
• Analyze claim data to detect trends, root causes of errors, and opportunities for process improvement.
• Generate actionable recommendations and implement claim adjustment solutions to optimize payment accuracy.
• Produce regular reports and dashboards for stakeholders on claim performance, defect status, and resolution outcomes.

Skills

Analytical skills

Problem solving

Communication

Leadership

MS Office

Education

Bachelor's Degree

Job description

Blue Cross Blue Shield of Michigan seeks a data-and-process professional to identify operational insights and develop workflows that improve customer service and reduce costs. You will lead projects, communicate milestones, and ensure compliance across departments.

Responsibilities include designing Medicare Advantage claims logic, configuring benefits, analyzing claims data, and producing reports for stakeholders. Strong analytical and communication skills are essential for success.