Manager, Risk Adjustment Analytics & Encounters

Manager Position

The Manager is responsible for providing leadership for the team who is involved in analytics, evaluation, modeling, and performance in support of customers to meet the growth, retention, membership, pricing and service goals for all group and individual product lines of BCBSM and BCN Senior Health Services for key accounts, auto / national, Trust funds, and mid-small groups, individuals, consultants, providers, vendors, and managing / general agencies / agents. Monitor / mentor multiple projects simultaneously ensuring appropriate model designs and statistic methods are adopted. Drive the continuous method improvement in department analytic work. Assist in the planning and implementation of programs to improve revenue, control cost, improve quality and efficiency of services delivered to BCBSM and BCN Senior Health Services populations. Prepare presentations and technical reports in a clear and concise manner to communicate finding from analytics, modeling to leadership and other interested parties and groups. Other duties may be assigned.

This role is also responsible for strategizing, innovating, analyzing, planning, organizing, budgeting, reporting, identifying equipment needs, and other functions that are required to maintain and operate an efficient and effective department.

Responsibilities / Tasks

Plans, organizes, and directs activities of an assigned business area, including, but not limited to, planning, training, motivation, staff development, staff selection, and communication. Manages staff that is responsible for delivering exemplary customer service or effective / efficient support (i.e. marketing strategies, communication materials, campaigns, etc.) from group, individual, or agent customers, including responding to inquiries which may include questions on products, programs, rulings, claims, and membership processing, as well as administrative questions that directly result in the retention of group or individual business. Maintains and promotes quality relationships with internal and external customers. Compiles and analyzes statistics and prepares activity related reports, manpower needs, and inventories and monitors all workflows within the unit. Leads and participates in workgroups and task forces in order to complete special assignments and projects. Coordinates and sets priorities that maintain continuity in accomplishing the sales and membership growth goals set for the department. Recommends processes to control supply expenditures and promotes efficient use of resources. Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations. Responsible for balancing workload to optimize the effectiveness of the department.

Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

Direction Exercised

Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

Employment Qualifications

Education : Bachelor's degree in Business Administration, Mathematics, Statistics, Data Science, Finance, Health Care Administration, or a related field required. Master's degree in a related field, certification or progress toward certification is highly preferred and encouraged. Continuous learning, as defined by the Company's learning philosophy, is required.

Experience : 5 years' experience of progressive responsibility in a business environment with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities required. Three years supervisory or lead experience in business required.

Skills / Knowledge / Abilities (SKA) Required : Excellent analytical, organizational, planning, verbal, and written communication skills required. Knowledge of current risk adjustment and revenue models, including CMS regulations and related impacts. Knowledge of CMS Encounter data and processes. Knowledge of health insurance and health care industry in general, more specific about BCBSM business, products, and programs. Strong Analytical skills (i.e. statistical methods, business process metrics, outcomes measurement, process modeling, quality assessment, etc.) Excellent verbal and written skills to communicate complex ideas. 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. Solid working knowledge of reporting tools and software : Excel, Access, PowerPoint, Word and Visio, as well as Statistical software (R preferred) Must be self-motivated and have the ability to work well under pressure. Ability to effectively present information and respond to questions from internal and external contacts at all levels of the organization. Ability to read, analyze, write, and develop communications (i.e. white papers, strategy decks, etc.) or reports as required by leadership. Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques. Ability to establish workflows, manage multiple projects, and meet necessary deadlines

Working Conditions : Work is performed in an office setting with no unusual hazards. Occasional travel is required.

Pay Range : Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $92,200 and $154,500.

EEO Statement : 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. Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract. Apply here.