Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

  • Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week

  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

  • Onsite: daily onsite requirement based on the essential functions of the job

  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.

This position is remote/hybrid within the state of AZ only

Purpose of the Job 

Claims Processors adjudicate incoming claims in accordance with policies, procedures, and guidelines (as outlined by the company) regulatory requirements and contractual agreements.  Processors are subject to production and quality standards to help ensure claims are processed correctly the first time. 
 

Qualifications 

REQUIRED QUALIFICATIONS 

Required Work Experience 

  •  1+ years 

Required Education 

  • High School Diploma or GED 

Required Licenses 

  • N/A 

Required Certifications 

  • N/A 

PREFERRED QUALIFICATIONS 

Preferred Work Experience 

  • N/A 

Preferred Education 

  • Associate's Degree in general field of study 

Preferred Licenses 

  • N/A 

Preferred Certifications 

  • N/A 

 

ESSENTIAL job functions AND RESPONSIBILITIES 

  • Adjudicate claims according to regulatory, contractual and health plan requirements 

  • Pre-screen accuracy of EDI submissions through review of data elements in claims system 

  • Verify claim is not duplicate of previously submitted claim 

  • Keep updated with processing manual and other educational/training materials 

  • Know and adjudicate claims according to COB provisions 

  • Identify and refer TPL issues to appropriate department 

  • Identify and refer medical review claims to appropriate department  

  • Identify and refer potential FWA claims to appropriate department 

  • Identify opportunities for provider education 

  • Identify opportunities for process improvement, including auto adjudication 

  • Perform all other duties as assigned  

  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements 

 

Competencies 

REQUIRED COMPETENCIES 

Required Job Skills 

  • Claims processing, including UB, 1500 and dental 

  • Medical terminology 

  • CPT/HCPC and ICD10 coding 

  • Medicaid and Medicare 

  • Experience with multi-tasking and prioritzing 

  • Type 30 to 35 words per minute with 5% error rate or less 

  • Intermediate PC proficiency 

  • Strong oral and written communication skills 

  • Proficient spelling, punctuation and grammar skills 

 

Required Professional Competencies 

  • Maintain confidentiality and privacy 

  • Compose and dictate a variety of business correspondence 

  • Interpret and translate policies, procedures, programs and guidelines 

  • Capable of investigative and analytical research 

  • Navigate, gather, input and maintain data records in multiple system applications 

  • Follow and accept instruction and direction 

  • Establish and maintain working relationships in a collaborative team environment 

Required Leadership Experience and Competencies  

  • N/A 

 

PREFERRED COMPETENCIES 

Preferred Job Skills 

  • Type >35 words per minute with 5% error rate or less 

  • Intermediate knowledge of CPT, HCPCS and ICD9 claim coding 

  • Intermediate understanding of dental and medical terminology 

  • Intermediate comprehension of anatomy and medical practices 

  • Bilingual (Spanish/English) skill in written communication 

Preferred Professional Competencies 

  • Knowledge of a wide range of subjects pertaining to the organization's service and operations 

Preferred Leadership Experience and Competencies  

  • N/A 

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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