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.

PURPOSE OF THE JOB

  • Performs proactive analysis and develops predictive models to assist business partners (vendors) with process management and opportunities for improvement.  Provides various types of documents and training material.  Coordinates and maintains management of train the trainer with vendor(s) for all work related to Provider calls being transitioned over to Vendors.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience
  • 3 years of experience in healthcare or customer service field
  • 3 years of experience in healthcare claims processing and coding
  • 1 year of experience in vendor interaction and/or management
Required Education
  • High-School Diploma or GED in general field of study
Required Licenses
  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience
  • 3 years of experience in data analysis
  • 3 years of experience in vendor interaction and/or management
Preferred Education
  • Bachelor's Degree in general field of study
Preferred Licenses
  • N/A
Preferred Certifications
  • Six Sigma Green Belt Certification
 

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

  • Maintain and update documentation for all relevant policy and procedures, desktop procedures, and any other relevant documents used by vendor(s) for ongoing processes.  This includes but not limited to Facilitator Training Documentation and Participant guides for new hires for the Vendor call centers.
  • Partner with vendor(s) and BCBSAZ internal areas to develop and maintain productivity strategies and measures related to calls received from BCBSAZ Providers
  • Maintain and modify, as necessary, any existing process as needed to Vendor’s SharePoint current and update to assist Providers
  • Function as the data expert for vendor(s) to assist management with emerging challenges and measurement needs
  • Performs independent high level and detailed analyses to identify patterns and trends that do not support desired results and be able to convey results of research or analysis to all audiences and answer all questions
  • Perform analysis and provide necessary business requirements to support changes to any process and or tool(s) for our Provider Assistant calls
  • Work closely with the Outsource Program Quality Analyst and the Process Improvement Analyst for the Provider Assistance Vendor (s) to update and communicate any changes to documentation, benefit and training needs.
  • Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms, benefits and manuals,

Process Improvements

  • Develop and maintain training documentation or provide necessary support and input to areas supporting training efforts
  • Work with internal areas to develop and coordinate materials for webinars as requested by management
  • Work with internal BCBSAZ departments on educational material and coordination of their deliverables
  • Responsible for staying abreast of product/member/provider issues, legislation, CMS mandates, policy changes and system changes so they can be considered for training topics 
  • Act as a "change agent", constantly challenging conventional thinking, approach, and ways of performing processes
  • Research business processes to define or interpret new or additional opportunities for data utilization
  • Perform root cause analysis to identify continuous process improvements and to improve provider satisfaction. Demonstrate initiative and resourcefulness in achieving goals and tasks as related to the divisions objectives
  • Meet deadlines in required timeframe established by management
  • Actively participate in the employee engagement process
  • Perform monthly Quality Reviews and provide feedback on staff assigned Inquiries
  • Provides coaching to staff for targeted areas needing improvement based on QC audit results

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones
  • Advanced PC proficiency
  • Advanced word processing, excel and database software
  • Understand claims processing logic and payment methodologies
  • Advance knowledge of Products sold by BCBSAZ to quote Benefits and Eligibility for members
  • Ability to create and update training material for vendor call centers

Required Professional Competencies

  • Capable of moderate investigative and analytical research
  • Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
  • Establish and maintain working relationships in a collaborative team environment
  • Interpret and translate policies, procedures, programs and guidelines
  • Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
  • Compose and dictate a variety of business correspondence
  • Maintain confidentiality and privacy

Required Leadership Experience and Competencies

  • Use available information to focus conversations and meetings
  • Use facilitator skills to move a group or team from beginning to end of a process

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

Preferred Professional Competencies

  • Knowledge of a wide range of subjects pertaining to the organizations service and operations
  • Knowledge of State, Federal and other regulatory requirements as they apply to healthcare issues

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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