Blue Cross Blue Shield of Michigan - Employment Opportunities - In Southeast Michigan

In Southeast Michigan

Account Manager

E-mail your resume and salary requirements (total compensation) in Microsoft Word (.doc) format to:
sking2@bcbsm.com. In the subject line designate job number 126900.

Expiration: 09/01/08
Reference Code: 126900

Job Summary:

Blue Cross Blue Shield of Michigan (BCBSM) is seeking an Account Manager in our Group Sales area. This individual will have the primary responsibility to retain and increase BCBSM and Blue Care Network membership within an assigned territory in southeast Michigan while managing the quality and consistency of product and service delivery within that territory. This position offers a solid benefit package, competitive salary and a marketing incentive program.

Duties and Responsibilities:

Activities will include administration, planning, strategizing and benefits consulting.

Education and/or Experience:

Four (4) years of health benefit account management experience is required in addition to a bachelor's degree.

Skills and Abilities:

Must display an expert level of communication skills along with attention to details, a sense of urgency and good follow–up skills.

Actuary Associate — Valuation Manager

E-mail your resume in Microsoft Word (.doc) format to:
Agelberman@bcbsm.com

Expiration: 09/01/08
Reference Code: AGMV

Job Summary:

The manager, Associate Actuary, analyzes and maintains the adequacy of actuarial reserves (including IBNR, RSR, supplemental liability, and stoploss), develops and enhances the actuarial process of reserve calculation, experience analysis and reporting, and market and product profitability analysis, as well as interacts with all financial areas of the corporation and external agencies. Directs and provide leadership in the design, pricing and implementation of products ensuring compliance with various state and federal regulations.

Duties and Responsibilities:

Plan and carry out projects using advanced level of knowledge and comprehensive understanding of complex actuarial principles and practices to resolve a variety of problems in the absence of guidelines or precedents. Utilize significant discretion in order to achieve necessary results.
Evaluate product line performance and the risk and appropriateness of assumptions used in product development.
Make initial determinations on reserves, dividends allocations and surplus forecasts.
Analyze the financial risks for various asset/liability matching scenarios and monitor the appropriateness of reserves.
May supervise several intermediate level professionals.
Other duties may be assigned.

Education and/or Experience:

Bachelor's degree in mathematics or related area preferred.
Minimum of five (5) years actuarial experience, including one (1) year at the Assistant Actuary level or comparable experience at another company.
Earned the ASA designation.

Skills and Abilities:

Knowledge and comprehensive understanding of complex actuarial principles and practices.>
Strong analytical, verbal and written communication skills.
Other related skills and/or abilities may be required to perform this job.

Supervisory Responsibilities:
Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Application Developer, Advanced

E-mail your resume in Microsoft Word (.doc) format to:
Klaw@bcbsm.com. List the Job Posting Number in the subject line.

Expiration: 07/10/08
Job Posting Number: KL-UK01
Hours: 8 a.m. to 5 p.m.

Job Summary:

Application Developer, Advanced wanted to maintain B13 Application; work on production problems, minor enhancements break-fixes, take care of problem tickets opened by customers and maintain batch jobs associated with the application; work very closely with the B13 business team; maintain the B13 Group portal and B13 IPAR Extranet applications.

Duties and Responsibilities:

Conduct analysis of organizational needs and goals for the development and implementation of application systems.
With general guidance and coaching, perform technical design and development of applications using existing and emerging technology platforms.
Design, code, test, debug documents and maintain those applications.
Ensure SDLC methodology is followed, conduct inspections and post implementation reviews
Work at a high technical level for the entire application development life-cycle; partner with business personnel to conduct analysis of organizational needs.
Act as a primary liaison with the user area for development and modifications to existing applications using significant creativity.

Education and/or Experience:

Requires Bachelor's degree in Business Administration with a concentration in Management Information Systems or Computer Science and either one (1) year of experience in the job offered or one (1) year of related experience as a Programmer Analyst.
The related experience must include: use of B13 application, B13 IPAR Extranet and SDLC methodology.

Application Developer Advanced

E-mail your resume in Microsoft Word (.doc) format to:
Klaw@bcbsm.com

Expiration: 06/30/08
Reference Code: KL-126641

Job Summary:

Business analysis, application architecture, design, development, integration and delivery. Application maintenance and support.

Duties and Responsibilities:

Conducts analysis of organizational needs and goals for the development and implementation of application systems.
With general guidance and coaching, performs technical design and development of applications using existing and emerging technology platforms.
Designs, codes, tests, debugs, documents, and maintains those applications.
Ensures SDLC methodology is followed, conducts inspections and post implementation reviews.
Competent to work at a high technical level for the entire application development life-cycle.
Partners with business personnel to conduct analysis of organizational needs.
Acts as a primary liaison with the user area for development and modifications to existing applications. Significant creativity is required.
Other duties may be assigned.

Education and/or Experience:

Bachelor's degree in related field preferred.
Minimum three (3) to five (5) years related experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
Other related skills and/or abilities may be required to perform this job.
Hands-on experience working with Dreamweaver and Flash.
Four (4) to five (5) years of development experience with ColdFusion, including user interface and components development.
Experience with SQL and database development, as well as JavaScript.
Well organized and attentive to detail.
Excellent verbal and written communication skills.

Preferred Experience:

General understanding of all phases of the BCBSM SDLC for both distributed and mainframe systems.
ColdFusion Report Builder.
Self starter and strong leadership skills.

Advanced Business Intelligence Analyst

E-mail your resume in Microsoft Word (.doc) format to:
sking2@bcbsm.com

Expiration: 12/31/08
Reference Code: 125998-SK
Openings: 3
Location: Detroit

Job Summary:

This position will help support internal and external stakeholders make informed decisions by analyzing and interpreting healthcare data and information through the application and development of advanced analytic tools and methods.

Duties and Responsibilities:

Customer presentations to provide healthcare analytics with value added findings and recommendations.
Conduct analyses of health care data and develop appropriate strategies to improve quality, utilization and costs.
Identify, investigate and define utilization issues/problems impacting cost, delivery and quality of health care services.
Demonstrate creativity in the design and analysis of projects with interpretation of results.
Resolution of customer inquires regarding data and healthcare analytics.
Recommend, communicate and implement solutions to identified problems/root cause of issues.
Develops rapport and effective partnering relationships with Group Sales and other business areas to enhance and strengthen the consultative experience between BCBSM and our Stakeholders.
Participates in the development and presentation of ongoing educational sessions both formally and informally to enhance the understanding of healthcare analytic issues by non analytic coworkers and acts as an analytic resource for Group Sales and other business areas.
Assist in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment with defined parameters.
Interface with programmers and developers to define and implement business intelligence tools and solutions for healthcare analytics and metrics reporting.
Communicate results and recommendations through meetings, presentations and written reports.
Serve as a consultant to internal and external customers.
Maintain state of the art analytical and PC skills.
Keep current with relevant health care issues and industry initiatives.

Education:

Bachelor's degree in business administration, health care, statistics or other related field is required.
Master's degree is a plus with a concentration in health care administration, community health services, health economics or business administration.

Experience:

Four (4) or more years experience in the development, evaluation, reporting and presentation of key performance metrics (including financial, utilization, clinical, satisfaction and operational) for employee benefits and welfare programs.
Knowledge of health care insurance products and general health care issues relating to quality, utilization and reimbursement of providers.
Experience with Microsoft Access and Excel or similar tools in order to perform database searches to respond to research questions and perform statistical analyses.
Strong data management skills including understanding of requirements determination, data organizational structures, organized testing approaches report design and development.
Superior analytical, communication, planning and coordination skills and ability to address complex issues technically, analytically and statistically.
Demonstrates excellent organizational, verbal and written skills to understand, interpret and communicate ideas, including the ability to present the results of their own analysis utilizing Microsoft PowerPoint or similar tool.
Ability to effectively interface with employees at all levels.
Other duties may be assigned to meet additional BCBSM business goals and objectives.

Additional Comments:
Applicant needs to be a highly motivated, creative and a critical-thinker who can analyze complex problems and present healthcare solutions to our stakeholders. Possess a history of providing exceptional customer service along with a demonstrated success applying project management skills and concepts to analytic tasks. In addition, you will need the ability to work both independently and in team environments on complex projects and issues with large financial and/or risk impact to the corporation.

Department Preferences:

ETG/ERG/EBM knowledge/experience.
Healthcare data groupers — DRG/APG/RVU knowledge/experience.
Trend analysis experience.
Cost and utilization analysis experience.
Plan design evaluation experience.
Analysis of statistical fluctuation and norms among provider and member health care utilization patterns.

Auditor Analyst — RN

E-mail your resume in Microsoft Word (.doc) format to:
KHughes1@bcbsm.com

Expiration: 06/20/08
Location: Detroit
Department: Professional Utilization Review
Reference Code: 126841

Description:

Responsibility 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.

Duties and Responsibilities:

Review of medical records.
Perform clinical reviews with knowledge of body systems, anatomy and physiology.
Assist and support in the planning, coordinating, developing and implementing of approved audit programs which are divisional and/or corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls and performance.
Analyze, process and/or expedite operational transactions; this may include timely resolutions of problems.
Participate in systems testing, develop procedures and controls and provide recommendations for the ongoing improvement of the updated process.
Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters, communications and graphics.
Assist internal and external personnel by answering questions, supplying information and training.
Develop and maintain an effective working relationship with customers or partners.
Other duties may be assigned.

Education:

Bachelor's degree in health related field preferred.

Experience:

Two (2) to five (5) years experience in related field required.
Demonstrated knowledge and competency in the following areas:
Thorough understanding of medical coding (CPT-4; HCPCS, ICD-9 or DRG) as it relates to audits.
Effective verbal and written communication skills.
Ability to lead and contribute to process improvement programs.
Excellent interpersonal skills necessary to interact with all levels of personnel.
Registered Nurse with current MI license.
Other related skills and/or abilities may be required to perform this job.

Certifications, Licenses and Registrations:

Registered Nurse

Auditor Analyst — RN/CPC

E-mail your resume in Microsoft Word (.doc) format to:
KHughes1@bcbsm.com

Expiration: 06/20/08
Location: Detroit
Department: Professional Utilization Review
Reference Code: 126859

Description:

Responsibility 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.

Duties and Responsibilities:

Review of medical records.
Perform clinical reviews with knowledge of body systems, anatomy and physiology.
Assist and support in the planning, coordinating, developing and implementing of approved audit programs which are divisional and/or corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls and performance.
Analyze, process and/or expedite operational transactions; this may include timely resolutions of problems.
Participate in systems testing, develop procedures and controls and provide recommendations for the ongoing improvement of the updated process.
Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters, communications and graphics.
Assist internal and external personnel by answering questions, supplying information and training.
Develop and maintain an effective working relationship with customers or partners.
Other duties may be assigned.

Education:

Bachelor's degree in health related field preferred.

Experience:

Two (2) to five (5) years experience in related field required.
Demonstrated knowledge and competency in the following areas:
Thorough understanding of medical coding (CPT-4; HCPCS, ICD-9 or DRG) as it relates to audits.
Effective verbal and written communication skills.
Ability to lead and contribute to process improvement programs.
Excellent interpersonal skills necessary to interact with all levels of personnel.
Registered Nurse with a CPC Certification (Certified Professional Coder)
Other related skills and/or abilities may be required to perform this job.

Certifications, Licenses and Registrations:

RN with CPC Certification

Cash Management Analyst

E-mail your resume in Microsoft Word (.doc) format to:
AGelberman@bcbsm.com

Expiration: 07/01/08
Location: Detroit
Reference Code: AGBLCMA

Description:

Responsible for daily cash position functions for BCBSM, BCN subsidiaries: LifeSecure, the foundation, stoploss and medical malpractice. Cash position functions will also include short-term investing, borrowing, initiating bank transactions and monthly reporting. Accountable for analyzing bank account activity, investigating miscellaneous transactions and problem resolution.

Essential Duties and Responsibilities:

Consolidate all cash flow information including account balances, disbursement reports and requests and investment information.
Determine daily cash position, investment opportunities and/or borrowing need.
Ensure dissemination of information to various departments within BCBSM and subsidiaries.
Fully utilize treasury workstation to position cash, reconcile accounts, forecast, download bank balances and transactions, and email reports to internal customers.
Ensure that fund transfer requests have appropriate signature authority.
Initiate wire transfers and ACH transactions. Maintain fund transfer database of each financial institution servicing BCBSM.
Maintain daily and monthly reports as it relates to each cash portfolios.
Ensure that bank transactions are reconciled daily. Verify prior day transactions, investigate miscellaneous items and apply appropriate measures to identify transaction origin.
Provide support to senior analyst and manager as it relates to special projects.
Provide courteous and accurate responses to customers and banking partners.
Prioritize work assignments to ensure that goals and deadlines are met.
Continually seek to improve work processes and make recommendations for enhancements.
Adhere to corporate and departmental policies, practices and procedures.
Perform other duties as assigned.

Education and/or Experience:

Bachelor's degree in finance, accounting, business administration or cash management experience is required.
Preferred two (2) years of experience in finance, accounting, treasury or cash management is preferred; however, entry level skills are acceptable.

Other Skills and Abilities:

Detailed knowledge of all applicable corporate policies, procedures and processes is preferred.
Good organizational, planning, analytical, verbal and communication skills.
Knowledge of PC related software applications is required.
Other related skills and/or abilities may be required to perform this job.

Compliance Specialist — Medicare Advantage

E-mail your resume in Microsoft Word (.doc) format to:
AGelberman@bcbsm.com

Expiration: 09/01/08
Location: Detroit
Reference Code: AGRNCS

Description:

Blue Cross Blue Shield of Michigan has a full time opening in our Corporate Compliance Office. This position will be responsible for monitoring the Medicare Advantage and Part D portion of our business to ensure compliance to the CMS audit guidelines.

This position provides guidance to corporate leaders and individual employees that identify compliance issues and recommend corrective action plans enterprise-wide. Consults with business areas and other subject matter experts to identify compliance requirements, assess risks, and recommend compliant solutions that support business goals. This position also acts as subject matter expert on applicable regulations (e.g. HIPAA, Medicare, etc.), training and awareness programs, and for responding to compliance-related inquiries.

Duties and Responsibilities:

Develop, implement and administer compliance monitoring programs, risk assessment and compliance processes.
Perform and lead compliance reviews and enterprise-wide compliance evaluations on an on-going basis.
Supervise corporate compliance senior analysts on assigned tasks, project risk assessments and manage relationships to help ensure efficient and effective solutions are implemented.
Develop detailed plans to address complex compliance issues by identifying goals, objectives and risks to achieving compliance objectives. Coordinate with business areas to implement corrective action plans when needed.
Investigate compliance and control issues to resolve complex problems and make recommendations to business leaders and employees to ensure on-going compliance.
Review and interpret new and existing regulations (e.g. HIPAA Privacy and Security, Medicare Parts C and D), and coordinate with legal staff to provide opinions on compliance issues. Maintain knowledge of regulations impacting the company and industry.
Develop compliance communications (e.g. Web site, content, compliance corner articles, presentations etc.) for various audiences as needed. Other duties may be assigned.

Education:

Bachelor's degree in related field required. Master's degree in business administration, additional related certifications preferred.

Experience:

Five (5) to seven (7) years in related health care field which may include experience in technical/systems, information security, compliance and/or audit and risk assessments. Leadership/supervisory experience preferred.
Ability to develop and present complex materials in a clear, concise and persuasive manner.
Working knowledge of HIPAA legislation, privacy rules, or security standards, or federal regulations related to Medicare Parts C and D, or advanced knowledge of risk assessment concepts and generally accepted auditing principles.
Ability to plan, organize, direct and control projects while exercising high ethical standards and good judgment.
Excellent analytical, organizational, interpersonal, problem solving, written and verbal communication skills, as well as the ability to apply concepts to practical situations.
Ability to work independently with minimal supervision, within a team environment and handle multiple assignments.
Working knowledge of PC applications (Word, Excel, PowerPoint and Outlook).
Other related skills and/or abilities may be required to perform this job.

Department Requirements:

Project management experience.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Strong healthcare and business knowledge.
Strong research and analytic skills.
Strong interpersonal skills.
Exceptional written and verbal communications.

Department Preferences:

Knowledge of Medicare Parts C and D regulations.
Working knowledge of generally accepted auditing principles.

Data Analyst — Medical Underwriting — Individual

E-mail your resume in Microsoft Word (.doc) format to:
AGelberman@bcbsm.com

Expiration: 09/01/08
Location: Detroit
Reference Code: AGDASG

Description:

Position to work with others in the Individual Underwriting area to create reports, identify data needs, analyze data, manage databases, understand data procedures and definitions within the corporation, network with other data managers to understand various repositories of data that are available. Would also assume responsibility to ensure rates are implemented in the systems in a timely and correct manner.

Duties and Responsibilities:

Work independently within guidelines, leads the design and implementation of data management for reporting, production, quality control.
Understands the various data repositories to help create reports that are needed.
Can supervise and create project requirements for systems outside of the position's scope.
Assure that corporate compliance is communicated, implemented and monitored on an ongoing basis.
Participate in system testing, developing procedures/controls and provide recommendations for the ongoing improvement of work processes.
Administers and understands data definitions within various data systems and repositories accessed by the individual Underwriting area.
Understands SQL for report development and design development.
Maintains documentation of systems and scripts created for Individual products.

Education:

Bachelor's degree required

Requirements and Skills and Abilities:

Knowledge of data and data quality is a requirement, along with working with large volumes of data either relational or sequential.
Advanced knowledge of programming with SQL is a requirement.
Experience creating reports and measuring effectiveness of processes
Experience testing systems and implementing systems.
Five (5) years of experience in a related field preferred
Excellent analytical, organizational, verbal, and written communication skills
Ability to listen to needs and develop reports or data analysis to answer questions
Ability to plan, organize, direct and control projects
Ability to lead and contribute to process improvement projects
High proficiency level in specific job related skills
Working knowledge of PC applications and/or mainframe required
Other related skills and/or abilities may be required to perform this job.
Ability to work in a team environment.

Dental Review Technician

E-mail your resume in Microsoft Word (.doc) format to:
yspruill@bcbsm.com

Expiration: 06/30/08
Location: Southfield
Reference Code: YS

Description:

Blue Cross Blue Shield of Michigan is currently in search for a qualified professional to fill the position as Dental Review Technician in our Southfield location.

Duties and Responsibilities:

Support the dental review section.
Process complex senior level claims.
Process complex turnaround documents.
Review dental pre-determination requests and provider treatment plans.
Interpret dental X-rays.
Review written treatment plans.

Education/Certification:

High school diploma or GED required.
Certification as a Dental Assistant required.

Required Skills/Experience:

Two (2) years clinical chaired dental assisting required.
Two (2) years experience in dental claims billing or processing.
Working knowledge of the health care industry.
Strong organizational, planning, analytical skills.
Excellent verbal and written communication skills.
Strong attention to detail.
Positive attitude.
Ability to multi-task.
Good time-management skills.
Knowledge of Word and Excel.

Preferences

Experience with dental policies as they relate to BCBSM dental contracts, claims processing

Director, Project Delivery

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration Date: 07-30-08

Reference Code: KL-127091
Location: Detroit

Summary:
The director is responsible for the delivery of large complex projects and solutions. Consulting to business executives, management of multiple functions, services and units, organizational mission, vision, objectives, structure, policy setting, strategic planning.

Duties and Responsibilities:

Oversee the progress of managers, support staff and senior technical personnel.
Lead and direct an organization responsible for part of the IS division's workload.
Identify the drivers, strategies and needs of client operations and lead internal change to support those operations.
Influence and support the culture, values and standards of the organization.
Direct, motivate and develop managers and other key personnel who report to them. Direct the development of corporate standards.
Direct review of tools and technologies for improving performance and reducing costs.
Work closely with business unit support and with appropriate business areas to ensure that business needs are understood and that services provided meet those needs.
Perform leadership duties, including performance reviews.
Possess wide latitude in determining creative solutions to strategic and operational needs.

Education and/or Experience:

Bachelor's degree in related field required. Master's degree in related field preferred.
Minimum ten (10) years related experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
A high proficiency level in specific job related skills are required.
Other related skills and/or abilities may be required to perform this job.
A proven track record of delivery complex projects and solutions.
Excellent written and oral presentation skills. Must be able to interact and present to top executives.
Ability to organize, recruit, staff and lead large teams composed of managers, support staff and senior technical personnel.
Experience dealing with vendors and negotiating service contracts.
Experience with applications development across multiple platforms, including Web.
Experience managing applications development/solution delivery performed by multiple teams/vendors on and offsite.
Experience in implementing packaged solutions to support business operations, including vendor management.
Experience in developing IT strategies in support of achieving business imperatives and in anticipation of future industry/marketplace trends in the healthcare, financial and insurance industries.

Preferred Experience:

Experience in the Healthcare and/or Health Insurance industries is preferred.
The ideal candidate will have Big Four experience providing services to clients.

Information Security Architect Senior

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration Date: 06-30-08

Reference Code: KL-126941
Location: Detroit

Summary:
The Information Security Architect Senior will have a firm grasp of the capabilities and limitations of information security technologies, as well as their role in an inter-related system of people, process and technologies to deliver an acceptable level of risk within the organization. Will be responsible for mentoring of information security architects and other information security resources.

Essential Duties and Responsibilities :

Identifying security requirements and recommending appropriate solutions to IT and business problems.
Partner with operations, compliance and administration teams to support the information security needs of their projects and ensure that risks are accurately identified and appropriately managed to the enterprise's accepted level of risk.
Participate in developing standards for information technology security practices.
Provides subject matter expertise in information security disciplines for the design of company's technology architecture and implementation of hardware and software infrastructure.
Identify and evaluate tools and techniques to be used for capture, modeling and analysis of information security architecture.
Analyze, review, customize and recommend security architectures for internal projects and initiatives.
Identifies, implements, and monitors best practices for information security architecture.

Education and/or Experience :

Bachelor's degree in related field required. Master's degree in related field preferred.
Minimum eight (8) years related experience preferred.
In-depth understanding of common operating systems (UNIX/Windows), networking protocols, databases, and Internet applications development.
Must have thorough knowledge in IS security components, principles, procedures and practices.
Must have a thorough knowledge with web application and Internet security. Must have a broad knowledge in information technology trends.
Demonstrated understanding of security principles, best practices, architectures, tools and processes in the areas of:
- Access control systems and methodology
- Identity management and authentication systems
- Directory services design
- Application security and systems development life cycle
- Encryption technologies
- Data and systems integrity controls
- Network and Internet Security
- Operational security controls
- Intrusion detection and prevention
- Network switching and routing
- Security assessment, ethical hacking
Experience in implementing security or regulatory standards such as PCI DSS, NAIC-MARS, or ISO 17799.
Ability to communicate security objectives orally and in writing to a variety of audiences.
Ability to work independently in a self-directed manner and collaboratively as a team leader or member of security team.
Ability to create and implement detailed action plans for security solutions.
Ability to understand legal and regulatory requirements and business drivers and priorities, and integrate these requirements into overall security design.
Familiarity with project management lifecycle and providing security consulting to project teams.
Ability to write security requirements and design documents.
Excellent analytical, organizational, verbal and written communication skills.
A high proficiency level in specific job related skills is required.
Other related skills and/or abilities may be required to perform this job.

Lead Analyst — Investments

E-mail your resume and salary requirements in Microsoft Word (.doc) format to:
AGelberman@bcbsm.com

Expiration Date: 07-01-08
Reference Code: AGJKLAI

Job Summary:

Responsible for providing investment analytics for BCBSM's operating invested assets. Responsible for supporting the Director of Investments, in projects and providing reports to assist investment accounting and the investment portfolio managers on an as add needed basis. Prepare, review and interpret monthly reports, quarterly reports, and works on miscellaneous projects.

Duties and Responsibilities:

Responsible for final preparation of monthly, quarterly and year end investment analytics reports.
Responsible for final preparation of year end reports (AM Best, Sarbanes Oxley, SRQ's).
Responsible for final preparation and review of quarterly Finance Committee and Board of Directors investment packages (including economic and Federal Reserve commentary).
Responsible for final monthly balancing of Yield Book analytical software to investment month end holding reports.
Monthly maintenance of the Yield Book software and preparation of monthly yield book benchmark reports, attribution analysis, system upgrades and problem solving with vendor.
Responsibility for interpreting and explaining the Yield Book reports at the monthly investment strategy meeting and to the portfolio managers.
Responsible for final review and reconciliation of monthly portfolio total return calculations for all portfolios.
Review of monthly packages for investment strategy meetings.
Responsible for final preparation of the investment income budgets and forecasts for BCBSM & Subsidiaries.
Review of Alternative Investment reconciliation.
Lead research and documentation of external Investment manager searches and make recommendations based on research.
Responsible for compliance reporting for BCBSM & Subsidiaries.
Liaison between the Investment Department, Subsidiary accounting Departments and BCBSM General accounting.
Preparation of the annual capital planning budget for the Actuarial Department.
Perform other related duties as assigned.

Education and/or Experience:

Bachelor's degree in finance or related field is required.
A minimum of three (3) years of analytical experience is required.
Minimum of (3) years of investment experience is preferred.
Enrollment in the CFA program or at minimum an MBA program preferred.

Skills and Abilities:

Good knowledge of Microsoft applications — Excel. Word, PowerPoint and others.
Excellent analytical, written and verbal communication skills.
Ability to assist and contribute to special departmental projects.
Knowledge of PC software and accounting applications is required.
Other related skills and/or abilities may be required to perform this job.
Knowledge of investment markets and securities structure is preferred.

Manager, Employee Benefits

E-mail your resume and salary requirements in Microsoft Word (.doc) format to:
klentz@bcbsm.com

Expiration Date: 07-01-08

Job Summary:

Responsible to design, direct, and lead the Employee Benefits department; specialize in development, planning, and leadership.

Responsibilities:

Manage activities of a department including but not limited to planning, problem solving, staff development training and communication.
Ensure that team members adhere to internal policies and procedures and external laws and regulations.
Research, analyze and develop information to support human resource policies and procedures in daily dealings with individuals and/or departments in the corporation.
Analyze business problems and devise solutions to these problems.
Assist personnel (internal and external) by answering questions and supplying information as necessary.
Prepare and present information to clients (internal and external) on Human Resource related topics.
Maintain professional knowledge in area of expertise through conferences, professional publications and seminars.

Responsibilities:

Bachelor's degree in business administration, human resource management or related area required. Master's degree in related field considered a plus.

Skills and Abilities:

Five (5) to ten (10) years experience in human resources or related area including experience in a leadership role.
Five (5) to seven (7) years experience of managing health and welfare welfare programs including workers compensation, wellness, Medicare and short term disability/long term disability programs.
Excellent analytical, organizational, problem resolution, verbal and written communication skills.
Ability to work effectively in a team environment.
Thorough knowledge of applicable human resource laws (i.e., ERISA, FMLA, FLSA, OHSA, etc.).
Strong PC skills including Microsoft Word, Excel and Powerpoint.

Department Preferences:

Preferred knowledge and experience of defined benefit and defined contribution plan administration.
Knowledge of PeopleSoft system or comparable payroll systems preferred.

Manager — Individual Business Underwriting

E-mail your resume and salary requirements in Microsoft Word (.doc) format to:
agelberman@bcbsm.com

Expiration Date: 09-01-08

Job Summary:

Lead the Individual Medical Underwriting staff.
Responsible for ensuring the maintenance and accurate application of underwriting policies and procedures.
Operate within broad objectives to ensure optimum utilization of capital, manpower, and equipment for the assigned business unit.

Duties and Responsibilities:

Ensure the review, evaluation and processing of individual business applications to determine underwriting eligibility, group requirements, and rate classification and risk.
Manage professional, exempt, and non-exempt non-bargaining and bargaining unit employees.
Provide high level of oversight and leadership.
Provide effective and efficient solutions to complex business problems.
Interact with project managers to ensure compliance with time lines and budgets.
Assist in the development of metrics to measure departmental objectives.
Effectively communicate with multiple internal departments and entities externally.
Lead the design, implementation, review, and evaluation of underwriting guidelines, processes, policies, and procedures.
Maintain strong knowledge of medical underwriting and health insurance processes and insurance laws that govern the individual market.
Draft correspondence for the agent community.

Education and/or Experience:

Bachelor's degree in nursing or related field required.
Five (5) to ten (10) years experience as a Medical Underwriter or Underwriting Supervisor in the health or life insurance field strongly preferred.
Three (3) years of supervisory or management experience preferably in Individual Medical Underwriting.
Health Insurance designations such as HIAA, LOMA, etc. strongly preferred.
Strong knowledge and understanding of underwriting decision process, medical terminology, medical record review, and health insurance benefit administration required.

Skills and Abilities:

Strong ability to understand and interpret company products, benefits, membership/billing policies and procedures as well as the corporate computer systems pertaining to individual contracts.
Strong ability to read and interpret medical records.
Ability to work under general direction.
Ability to work effectively in a team environment.
Excellent decision making, analytical, and verbal communication skills.
Strong technical writing skills.
Proficient in current industry standard PC applications and systems.
Other related skills and/or abilities may be required to perform this job.

Manager, Risk Management Services — Treasury Services

E-mail your resume in Microsoft Word (.doc) format to:
agelberman@bcbsm.com

Expiration: 09/01/08
Reference Code: MRSAG

Job Summary:

Responsible for the development, recommendation and administration of risk management and loss prevention programs.
Ensure compliance with safety legislation, industry practices and market requirements involving organization products.
Responsible for the design, development, implementation and maintenance of comprehensive business recovery plans.

Duties and Responsibilities:

Develop and implement risk management strategies tailored to BCBSM corporate needs and insurance market conditions, including carrier and broker selection, limits, deductibles and appropriate use of self-insurance.
Identify hazard risks to assets and earnings of BCBSM and subsidiaries from property and liability exposures and implement strategies to reduce possible claims.
Implement risk control measures to reduce or eliminate hazards.
Renew existing insurance portfolio on a cost-effective basis with appropriate coverages.
Provide business recovery consulting to vice presidents, directors and managers and coordinate all corporate business recovery planning efforts.
Manage the recovery operations of any department experiencing an event of any interruption to normal business activity(s) for a period of time that may possibly create a devastating affect on corporate finance, operations or customer relations.
Evaluate and identify risk management issues for acquisitions.
Review contracts for appropriate insurance and indemnification language.
Monitor carrier, broker and consultant performance.
Perform all department managerial administrative duties and administer corporate personnel policies and procedures.
Perform other related duties as assigned.

Education and/or Experience:

Bachelor's degree in related field required and CPCU, ARM, or J.D. designation is preferred.
A minimum of ten (10) years insurance carrier, broker or risk management experience is required.
Specific experience with large account risk financing or risk management experience is required.

Qualifications:

Knowledge of insurance principles and risk control theory with a background in risk management, risk financing, law and contracts are required.
Ability to work effectively in a team environment.
Good analytical, organizational, planning, verbal and written communication skills.
Knowledge of PC and software applications including Word, Excel and RIMIS is required.
Responsible for the overall direction, coordination, and evaluation of risk management business unit.
Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Operations Developer, Advanced

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration: 06/30/08
Reference Code: KL-126751

Job Summary:
Operation of production systems and equipment, production scheduling and control, reports distribution, service level support, backup, recovery, capacity and disaster recovery planning. This position will require both distributed (Unix and Windows) and Mainframe experience to help maintain and administer s/w products and provide production support.

Duties and Responsibilities:

With general guidance and coaching, plays lead role in production support activities for all major systems and related subsystems.
Insures that up-to-date job control language is maintained and documented for each program that is part of a scheduled production run.
Customizes operations infrastructure software.
Develops and enforces corporate production standards.
First level support for all production applications and processes. Performs database recovery.
Develops and installs automation of manual functions.
Leads requirements determination and design for production support activities.
Contributes to job scheduling and report distribution as well as data center standards development and enforcement.
Researches industry best practices and tools, provides recommendations to management.
Other duties may be assigned.

Education and/or Experience:

Bachelor's degree in related field preferred.
Minimum three (3) to five (5) years related experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
Significant creativity is required.
Other related skills and/or abilities may be required to perform this job.
Three (3) to five (5) years of experience with Unix shell scripting.
Three (3) to five (5) years of experience with MVS, zOS, Mainframe.
Experience maintaining, upgrading and administration of s/w products.

Preferred Experience:

Working knowledge of Tivoli Workload Scheduler or other distributed batch scheduling tools.
Working knowledge of Connect Direct, FTP, Exceed.
Working knowledge of FTP to and from the Mainframe environment.
Microsoft Office (all).
Distributed Languages; JAVA, HTML, XML, Unix shell script, Windows DOS script.
Mainframe Languages; SAS, CLIST, MVS JCL.

PeopleSoft Functional Analyst

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration: 06/30/08
Reference Code: KL-126849
Location: Detroit

Job Summary:
The PeopleSoft Functional Analyst position provides expertise in PeopleSoft Financials including AP, GL, T&E, PO, AM, Budgeting, and Commitment Control modules. Business analysis, application architecture, design, development, integration and delivery. Application maintenance and support.

Duties and Responsibilities:

Responsible for requirements and functional architecture analysis.
Involved in testing, training, and implementation of applications.
Formulates and defines system scope and objectives based on user needs and thorough understanding of business processes.
Works with internal business groups on process improvement projects designed to improve business results.
Provides guidance concerning business implications of application development projects.
With general guidance and coaching, gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group.
Other duties may be assigned.

Education and/or Experience:

Bachelor's degree in related field preferred.
Minimum three (3) to five (5) years related experience preferred.
Functional PeopleSoft experience with the following modules: AP, GL, T&E, PO, AM, Budgeting, and Commitment Control including demonstrated knowledge in one or more of the following areas:
- PS Query
- PS Security & Workflow
- PS nVision
- PS Chartfield Maintenance
- PS Tree Maintenance
System testing experience including demonstrated experience with the following: test planning, test case development, test execution, and issue resolution.
Demonstrated experience in development of business requirements, product configuration, fit-gap analysis and functional design documentation.
Proven experience in production support and upgrade activities for PeopleSoft applications.
Expert in identifying and understanding the essential problems and opportunities, including the ability to articulate the needs associated with them.
Ability to manage competing priorities.
Proficient with Microsoft Excel and Access.
Excellent analytical, organizational, verbal and written communication skills.
Significant creativity is required.
Other related skills and/or abilities may be required to perform this job.

Preferred Experience:

Experience with Ariba is a plus.

PeopleSoft Benefits Administrator

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration: 07/30/08
Reference Code: KL-127047
Location: Detroit

Job Summary:
Internal or external customer service and relationship management, first line of support, desktop technology support and help desk, site support. Monitor daily event activities generated by job changes and employee self service. Validate event processing statuses via reports, queries, processing messages. Analyze and resolve individual employee event processing issues that result from eligibility discrepancies, out of sequence processing, inaccurate data, etc. When proper documentation has been received from individual employees, generate life events making requested enrollment change. Analyze and resolve payroll errors that are a result of benefit program and plan enrollments. Assist with Open Enrollment activities, including monitoring status' and resolving eligibility and enrollment issues. Manage event coordination and reprocessing. Generate ad-hoc queries to assist in resolving potential eligibility, enrollment, or payroll issues.

Duties and Responsibilities:

With general guidance and coaching, provides analytical support to a specific group of customers on business applications, infrastructure and technology related activities.
Acts as a project team member, specifically on requirements definition and testing activities.
Provides guidance, assistance, coordination and follow-up on complex problems and ensures resolution.
Assists customers on their migration to new or revised products, applications and platforms.
Works with application developers and operations personnel to support production applications and customer-specific operations.

Education and/or Experience:

Bachelor's degree in related field preferred.
Minimum three (3) to five (5) years related experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
Significant creativity is required.
Other related skills and/or abilities may be required to perform this job.
Customer support related experience.
PeopleSoft HRMS experience with PeopleSoft benefits administration and COBRA / Benefits Billing.
Experience in supporting and resolving benefits administration event maintenance issues and daily transactions.
Experience processing Open Enrollment transactions.
Basic knowledge/ understanding of HR, benefits, and payroll regulations.
Basic knowledge/ understanding of PeopleSoft HR, benefits, and payroll processing.
Experience with PeopleSoft Query.
Proficiency with Windows, Microsoft Office and Excel.
Familiar with BCBSM benefit programs.
Must have strong analytical skills.
Must be well organized, able to prioritize and handle multiple concurrent tasks, and be able to manage sensitive data and/or information in a confidential manner.
Ability to function independently.

PeopleSoft HCM Analyst

E-mail your resume in Microsoft Word (.doc) format to:
klaw@bcbsm.com

Expiration: 07/30/08
Reference Code: KL-127044
Location: Detroit

Job Summary:
Business analysis, application architecture, design, development, integration and delivery. Application maintenance and support. Evaluate new system requirements as they relate to human resources, benefits and payroll functions. Identify and implement functional requirements for planned changes. Establish and maintain table configuration based on system requirements. Perform unit testing to validate configuration changes. Facilitate end-to-end testing to validate full impact of configuration changes. Identify reporting and interface requirements. Develop query solutions when possible. Document requirements for technical development where necessary. Develop and maintain process documentation to promote efficient process flow within each of the functional areas and across the system. Resolve operational issues that arise. Serve as the expert regarding system functionality and troubleshooting system issues. Serve as the liaison between functional and technical groups.

Duties and Responsibilities:

Top level technical expert in multiple specialized phases of application development.
Working independently within guidelines, provides technical consulting on complex projects considering equipment capacity, limitations, operating time and desired results.
Creates detailed technical designs and develops applications using existing and emerging technology platforms.
Writes new systems or applications of high complexity and scope, utilizing standard procedures and techniques.
Conducts analysis of organizational needs and goals for the development and implementation of application systems.
Partners with business personnel to conduct analysis of organizational needs.
May have senior quality assurance review responsibilities and duties including instructing, directing and reviewing work and responsibilities of other development team members.

Education and/or Experience:

Bachelor's degree in related field preferred.
Minimum five (5) years related experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
Extensive creativity required across areas of expertise.
A high proficiency level in specific job related skills is required.
Other related skills and/or abilities may be required to perform this job.
PeopleSoft HRMS 8.9 functional and/or technical experience.
Benefits administration and payroll support experience.
Customer service/user support related experience.
Basic knowledge/understanding of HR, benefits, and North America payroll regulations and processing.
Experience in configuring HR, benefits administration and North America Payroll.
Experience with PeopleSoft Query and SQL.
Experience in facilitating end user training.
Experience in creating and refining business process documentation, end-user documentation and job-aids.
Experience in collecting reporting requirements from business owners and end-users, creating design documentation, and developing queries and reports to serve key business users.
Proficiency with Windows and Microsoft Office and Excel.
Must have strong analytical skills.
Must be well organized, able to prioritize and handle multiple concurrent tasks, and be able to manage sensitive data and/or information in a confidential manner.
Ability to function independently on assigned project work, and interface with all levels within the organization.

RN Analyst I

E-mail your resume in Microsoft Word (.doc) format to:
khughes1@bcbsm.com

Expiration: 07/11/08
Reference Code: KH-125987
Department: BlueHealthConnection
Location: Southfield

Job Summary:

Responsible for providing clinical and technical support for the assigned area(s). Responsible for utilizing the nursing process in the development, implementation, monitoring and evaluation of educational plans and goals to support patient disease management, specialty assessment, telephone triage and health education.

Duties and Responsibilities:

Assist project team with the resolution of problems, conduct special assignments as requested and prepares reports and/or analysis documenting the results with recommendations to management.
Assist with the design, development, modification, testing, implementation and maintenance of assigned systems.
Troubleshoot problems and submit recommendations. May be required to interface with other areas, either internally or externally, to resolve problems.
Compile and analyze data and produce routine and non-routine reports, presentations, letters, communications and graphics.
Assist personnel (both internal and external) by answering questions, supplying information and training.
Other duties may be assigned.

Education:

Associate's degree in nursing or RN diploma required.

Experience:

One (1) to two (2) years of clinical experience. Two (2) to five (5) years preferred.
Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
Excellent written and verbal communication skills.
Working knowledge of PC applications.
Telephone triage experience preferred.
Med/Surg and ER experience preferred.
Health coaching experince preferred.
Exhibits enthusiasm and team community approach.
Demonstrates active listening skills.
Home care/community care experience preferred.
Other related skills and/or abilities may be required to perform this job.

Certifications, Licenses and Registrations:

Registered nurse with current Michigan registered nurse license required.

Additional Comments:

Department is a 24/7 operation. Positions are for afternoon shift. Saturday/Sunday and holiday work is required.

RN — Case Manager

E-mail your resume in Microsoft Word (.doc) format to:
KHughes1@bcbsm.com

Expiration: 07/11/08
Reference Code: RNB02
Area: Case Management, Specialty Programs and Specialty Groups
Location: Southfield

Job Summary:

A BCBSM Case Manager works with patients and providers to ensure that available health care resources are being used in a timely and cost effective manner.

Responsible for utilizing the nursing process in the development of treatment plans, with established goals, implementation of those plans, and monitoring and evaluation of an assigned case load of patients in order to provide them with the quality care appropriate to meet their clinical needs.

Duties and Responsibilities:

Reviews and analyzes referrals from a variety of sources for acceptance into the program.
Troubleshoots problems and submits recommendations. May be required to interface with other areas, both internally and externally, to resolve problems.
Consults and collaborates with medical consultants, medical directors, professional team and health care providers to develop treatment plans and goals on an as needed basis.
May develop educational and treatment plans by working with the patient and/or designee and family in agreement with physicians that will assure safe and cost effective quality of care.
Reviews status of patient in regards to established goals as appropriate.
May contact health care providers for assessment of the clinical status of the patient.
May analyze clinical reports utilizing approved standards and document results attained.
May conduct patient home visits to guarantee that the setting is safe and that medically necessary services are being delivered and that treatment goals are realistic and attainable on an as needed basis.
Coordinates discharge planning initiatives on an as needed basis.
May perform clinical review of claims to ensure that correct reimbursement for covered and/or approved services occurs.
May perform internal peer review for quality performance.
May assist with the design, development, modification, testing, implementation and maintenance of assigned systems.
Assumes leadership responsibilities when necessary.

Education:

Associate degree in nursing or RN diploma required. Bachelor's degree preferred.

Experience:

Two (2) to (4) years of clinical experience, preferably in Case Management or Home Health Care with a Medical/Surgical background.
Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
Working knowledge of Case Management principles and procedures based on nationally recognized standards of Case Management.
Excellent analytical, organizational, verbal and written communication skills.
Ability to work independently and in a team environment.
Ability to be flexible and to manage multiple tasks.
Good working knowledge of PC applications.
Other related skills and/or abilities may be required to perform this job.
Knowledge of BCBSM benefits preferred.

Certifications, Licenses and Registrations:

Registered Nurse with current Michigan Registered Nurse license required.
CCM certification is a plus.

Senior Analyst — Pharmacy Services

E-mail your resume in Microsoft Word (.doc) format to:
KHughes1@bcbsm.com

Expiration: 07/11/08
Reference Code: KH-126347
Area: Pharmacy Services
Location: Southfield

Job Summary:

Responsible for the development and provision of reports and analyses concerning the BCBSM prescription drug programs to both internal and external customers. Will be required to provide in-depth analyses of utilization, and to identify and explain aberrancies. May be asked to chair workgroup. Will be required to do developmental work with respect to reports and databases. Must be knowledgeable of the full spectrum of analytical tools/ methodologies in order to develop solutions in the absence of guidelines or precedents. This includes documented experience using Access, Excel, using the Data Warehouse, and developing ad hoc reports as well as report templates. Adheres to requirements of corporately approved processes/standards. Understands complex and sensitive issues and information, analyzes complex requests, conceptualizes issues and solutions in an unstructured, dynamic, multidisciplinary environment.

Duties and Responsibilities:

Develop and improve work flows and business processes within area(s) to improve customer service, decrease operational costs and improve overall quality.
Identify and/or analyze business problems and devise procedures for solutions to the problems.
Effectively lead projects/teams in order to produce desired results.
Responsible for corporate communication of project results.
Recommend and assist with implementing standard policies and procedures for providing routine service.
Assure 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.
Assist personnel (both internal and external) by answering questions, supplying information and training.
Develop and maintain an effective working relationship with customers.
Other duties may be assigned.

Education:

Bachelor's degree in related field preferred.

Experience:

Four (4) to seven (7) years experience in related field.
Demonstrated proficiency in Microsoft Word, Excel, Access, and Powerpoint.
Demonstrated ability to handle multiple projects simultaneously and assume responsibility for meeting deadlines.
Strong analytic capability.
Ability to effectively represent Pharmacy Services in corporate workgroup meetings.
Supervisory and/or Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities.
Ability to plan, organize, direct and control projects.
Excellent written and verbal communication skills.
Ability to lead and contribute to process improvement projects.
Knowledge of BCBSM's prescription drug programs and the pharmacy benefit management (PBM) industry highly desirable.
Other related skills and/or abilities may be required to perform this job.

Senior Benefits Specialist — HR

E-mail your resume and salary requirement in Microsoft Word (.doc) format to: klentz@bcbsm.com.

Expiration: 07/01/2008
Reference Code: KL126636
Area: Employee Benefits Department
Location: Detroit

Job Summary:

Coordinate various Human Resources functions including benefits administration and employee health. This position will assist employees with their health and welfare inquiries. Process life insurance claims. Assist in the development of the Summary Plan Descriptions and Plan documents for the various employee benefits.

Duties and Responsibilities:

Independently resolve more complex employee and management inquiries that arise as a result of daily work routines abiding by all corporate and employee policies and procedures.
Develop plans for proposed human resources systems; monitor the implementation and operation of approved systems.
Lead work groups composed of various areas in the corporation to complete projects and/or tasks.
Identify and analyze business problems and devise procedures and solutions to the problems.
Assist personnel (both internal and external) by answering questions, supplying information and training as necessary.
Develop, maintain and produce monthly, quarterly or annual reports as required.
Research, analyze and develop information to support human resources policies and procedures in daily dealings with individuals and/or departments in the corporation.
Prepare presentations on human resources related topics.
Provide information for internal and external audits and market surveys as necessary.

Education::

Bachelor's degree in computer science, business administration, human resources management or related area required.

Experience::

Five (5) years experience in the human resources environment or related experience. Excellent analytical, organizational, problem resolution, verbal and written communication skills.
Must be self-motivated, able to work independently and within established deadlines. Proficient in current industry standard PC applications and systems (i.e., Excel, Word). Thorough knowledge of applicable Human Resources laws (i.e., ERISA, FLSA, OHSA, etc.).
Knowledge of employee health and welfare care plan offerings that include various health care options, life insurances, EAP programs and disability programs.
Excellent verbal and written communication skills.
Medicare knowledge.
Proficient in PC applications, i.e. Microsoft Word, Excel and Powerpoint.
Knowledge of Peoplesoft system preferred.
Knowledge of Medicare preferred.

Systems Analyst, Corporate Project Services

E-mail your resume and salary requirement in Microsoft Word (.doc) format to: klaw@bcbsm.com.

Expiration: 07/30/2008
Reference Code: KL-127134
Location: Detroit

Job Summary:
System analysis, create requirements and designs for requested report enhancements. Develop and deliver new or enhanced reports. Create and develop moderate to complex queries. Provide support to a large user base.

Essential Duties and Responsibilities:

Under general direction and coaching, participates in developing functional requirements, testing, training on and implementation of applications.
Collects and defines requirements, translates into functional design documents and participates in the technical design, test planning and user documentation processes.
Participates in software design/prototyping and testing of new or enhanced applications.
Works with users and peers in planning, developing, implementing, and supporting new or existing applications.
Analyzes and re-engineers business processes.

Education and/or Experience::

Bachelor's degree in related field preferred.
Minimum one (1) to three (3) years overall programming experience preferred.
Excellent analytical, organizational, verbal and written communication skills.
Ability to create moderate to complex queries using SQL.
Experience with all phases of the software development life cycle (SDLC).
Demonstrated understanding of object oriented programming and design principles.
Experience working with industry leading project management tools, including Microsoft Project Enterprise.
Other related skills and/or abilities may be required to perform this job.
Ability to work independently on multiple assignments.

Preferred Experience::

Minimum one (1) to three (3) years Microsoft SQL Server 2000 preferred.
Crystal Reports or equivalent report writer experience preferred.
Experience working with Rational tools is preferred.

Pharmacist/Sr. Pharmacy Analyst

E-mail your resume and salary requirement in Microsoft Word (.doc) format to: khughes1@bcbsm.com.

Expiration: 07/11/2008
Reference Code: 126590
Area: Pharmacy Services Administration
Location: Southfield

Job Summary:
Responsible for promoting appropriate benefit designs for prescription drugs to sales staff, agents and customers. This position is also responsible for the education of sales staff and agents regarding the available benefit designs in order to advance corporate efforts to increase market share and provide cost-effective benefit designs. The incumbent responds to RFP's, RFI's and questionnaires for prescription drug benefits. Responsible for obtaining and retaining enrollment and assist in improving and maintaining stakeholder satisfaction with our commercial prescription drug programs. This position serves as a Pharmacy Services liaison and subject matter expert on the prescription drug programs to Marketing and Sales, which includes forming relationships with clients, agents, consultants and internal areas to educate, consult and promote the value of our prescription drug programs.

Duties and Responsibilities:

Prepare and conduct presentations or educational programs to various audiences, including customers, agents and internal marketing departments.
Provide accurate and timely responses to prescription drug Requests for Proposal (RFP), Requests for Information (RFI), and questionnaires for both Local and National groups.
Coordinate with BCBSM prescription drug vendor to compile RFP, RFI and questionnaire responses that are the vendor's responsibility.
Review of prescription drug RFP, RFI and questionnaire responses compiled by other corporate areas or our prescription drug vendor to ensure their accuracy and integrity.
Draft and coordinate various communications for distribution to internal departments and external customers, including marketing pieces.
Review non-standard benefit requests and provide approval/disapproval in accordance with corporate direction and systems capabilities.
Serve as contact/representative to Sales Liaison, NASCO systems and special projects, including community initiatives/task forces.
Interface with external customers/contacts, various internal departments and with our prescription drug vendor to resolve outstanding issues.
Serve as liaison to BCBSM prescription drug vendor's marketing support staff. Serve as contact to internal corporate areas and external customers/contacts to assist in the processing of problematic claims.
Must be willing to travel within the State and provide own transportation. Overnight business trips maybe occasionally required.
Other duties may be assigned.

Education::

Bachelor's degree in pharmacy required.

Experience::

Marketing experience in pharmacy environment preferred.
Must have excellent verbal and written communication skills with the ability to organize and demonstrate knowledge during individual/group presentations.
Must be able to function independently with minimal supervision and have the ability to set priorities with the objective of completing numerous activities with short turnaround time frames.
Ability to interface with department staff, numerous internal departments, external customers, agents and subscribers.
Knowledge of BCBSM prescription drug programs, certificates and riders, non-standard benefits, and marketing structure.
Proficient in Word, Excel, and PowerPoint.
Excellent communication skills, including public speaking.
Ability to work effectively in groups to drive results within mandated timelines.
Ability to multi-task and work under tight deadlines.
3-5 years of managed care pharmacy experience preferred.
Familiarity with vendor systems and capabilities.
Other related skills and/or abilities may be required to perform this job.

Certifications, Licenses and Registrations::

Current Michigan Pharmacist license, or acquisition of Michigan Pharmacist license within six (6) months of start date.

Senior Health Care Analyst

E-mail your resume and salary requirement in Microsoft Word (.doc) format to: khughes1@bcbsm.com.

Expiration: 07/11/2008
Reference Code: 126317-KH
Area: Wellness and Care Management Consulting
Location: Southfield

Job Summary:
The Wellness & Care Management Consulting department is responsible for collaborating with the Group Sales Division to interact with customers to better understand their wellness and care management needs, educate them about resources offered by BCBSM and helps employers select a wellness and care management solution tailored to their needs.

Applicant will be responsible for working directly with customers to identify their unique wellness & care management needs, provide them with tailored solutions and guide them through the process from design to rollout. Applicant will need to possess excellent presentation skills and have the ability to explain complex concepts to a variety of internal and external audiences. Strong analytic and consulting skills necessary to help customers interpret and understand data to find solution that fits their population.

Responsible for planning, organizing, directing, implementation, and leading department assignments. Position operates within broad objectives to ensure optimum utilization of manpower and budget. Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements.

Duties and Responsibilities:

Leads in the research, analysis, identification and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
Develop lines of communication to discuss/review results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
Investigate, review, recommend, communicate and implement solutions which identify problems/root cause of issues.
Identify and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities.
Independently develop and plan, reports, papers and/or other materials in a clear and concise manner.
Provide expertise and guidance to unit and corporate staff as required.
Acts as liaison between corporate business areas and participates in group or committee discussions.
Create and make sales presentations to key existing and potential BCBSM customers as the sole representative of the Wellness and Care Management department or as part of a team that is working closely with Marketing and Sales.
Work as a liaison between operational and program areas and the customer in conjuction with Marketing and Sales staff.
Conduct analyses of BCBSM claims, memebership and financial data to assess customer needs and opportunities.
Other duties may be assigned

Education::

Health Services Administration, Kinesiology and Public Health, or Marketing as a field of education.
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.

Experience::

Six (6) or more years experience in related experience, typically in two (2) subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).
Excellent analytical, planning, problem solving, verbal and written skills to communicate complex ideas.
Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.). Strong working knowledge of data languages such as SAS or SQL.
Ability to work independently, within a team environment and communicate effectively with employees at all levels.
Extensive experience developing and conducting presentations to diverse audiences. Strong communication skills (written and verbal) are required to understand, interpret , and communicate Wellness & Care Management concepts and solutions.
Highly motivated with a history of providing exceptional customer service. Demonstrated ability to function as a positive ambassador of the corporation with attitudinal qualities to service and retain customers.
Creative problem-solver with superior analytical skills Able to work with internal and external clients to identify needs and develop solutions.
Extensive knowledge of BCBSM business and programs, internal and external environment as well as knowledge of general health care issues relating to wellness & care management.
Solid working knowledge of reporting tools and software: Excel, Access, PowerPoint, Word and Visio.
Must possess valid, non-restricted Michigan Operator License as travel to customer sites may be required.
Strong presentation skills and experience in working with external customers.
Demonstrated ability to interpret qualitative and quantitative analyses. Familiarity with financial analysis, concepts of return on investment and financial risk.
Demonstrated ability to handle a variety of assignments simultaneously in a fast-paced environment.
Capacity to quickly grasp complex concepts and to interface with various levels of business experts.
Demonstrated ability to work effectively with various corporate areas including Medical Informatics, Clinical Program Development, BlueHealthConnection Operations, Marketing & Sales, Underwriting and the Business Intelligence Center.
Possess and maintain comprehensive understanding and knowledge of BlueHealthConnection components and solutions and how they integrate with BCBSM products and programs is preferred.
Familiarity with concepts of Wellness and Health Promotion and understanding of Care Management processes.
Ability to function well independently and work effectively as part of a team.
Sales and Marketing experience a plus.
Other related skills and/or abilities may be required to perform this job.

Additional Comments::

Travel throughout the State of Michigan is required.

Senior Information Security Compliance Analyst

E-mail your resume and salary requirement in Microsoft Word (.doc) format to: klaw@bcbsm.com.

Expiration: 07/30/2008
Reference Code: KL-127066
Location: Detroit

Job Summary:
This position focuses on the role of Information Security Compliance. This position is responsible for coordination of security compliance efforts that are required for security access, audit response, security awareness, information security policies and standards, policy exception oversight, and information security risk management.

Essential Duties and Responsibilities:

Monitors regulatory environment for impact on security programs and initiatives.
Develops policies, procedures and standards to ensure and enhance security.
Educates customers on security policy and practices.
Create information security risk assessment methodology and perform information security risk assessments based upon approved methodology.
Assists in development of annual information security risk assessment plan.
Responsible to lead internal regular information security risk assessments to ensure proper use of any security,