Teams at Blue Cross & Blue Shield of Mississippi

Reviews medical records, claims, analytical findings, complaints, referrals, and appeals for inappropriate care, utilization, billing, and potential fraud, waste, and abuse. Applies clinical guidelines, provider contracts, benefit plans, medical policies, and coding standards. Consults with medical and legal teams, recommends corrective interventions, and prepares objective, evidence-based audit reports and conclusions.

The Senior Systems Analyst analyzes business requirements, creates technical specifications, develops mainframe applications, and maintains claims applications while providing expert consultative support.

The Marketing & Development Manager drives sales, partners with agents for training and marketing, and ensures retention goals are met.