Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

Leads the BlueCard operational teams in the delivery and execution of timely, accurate and high quality service in accordance with association guidelines and measures.  Champions customer experience initiatives while eliminating waste and improving efficiencies within BlueCard operations.  Works in close partnership with the Inter-Plan Executive to ensure compliance with BlueCard policy. 

 

ESSENTIAL job functions AND RESPONSIBILITIES

 

 

CLAIMS AND CUSTOMER SERVICE

  • Develop strategy and manage operations to ensure quality customer service and timely accurate processing of BlueCard claims.
  • Track and report customer service metrics, both internally and to the BCBS Association.
  • Monitor and maintain performance levels to meet national standards for all applicable lines of business.
  • Resolve problems, complaints, and difficult claims settlements related to production
  • Ensure customer service staff is properly trained to provide full service to customers, by phone, in writing, or electronically.
  • Ensure staff compliance with security and privacy requirements, including HIPAA and CodeBlue

QUALITY AND SYSTEMS

  • Lead the development of enhancements to existing systems and the creation of new systems to improve quality and efficiency within BlueCard Operations.
  • Partner with Inter-Plan Executive and work in conjunction with Product Owners in the management of Inter-Plan Programs systems implementation and modification activities and BCBSA and PlanConnexion applications and systems.
  • Monitor quality performance measures, develop and maintain effective workflows, and maximize system efficiencies.

BLUECARD LEADERSHIP

  • Maintain knowledge associated with Association Programs, Policies and Provisions
  • Partner with Inter-Plan Exec. to manage communications and decisions related to Inter-Plan Programs and other Inter-Plan functions
  • Monitor and report to the BCBS Association compliance and certifications as required
  • Partner with the Inter-Plan Exec. in the management of Inter-Plan activities for national account implementations for BCBSAZ as a Control and Par Plan
  • Deliver against Inter-Plan Programs performance measurements
  • Maintain relationships with the BCBSA and staff of other Plans on issues related to Inter-Plan Programs and expected impacts of proposed Program enhancements.
  • Participate in Association workgroups, committees &  task forces as required.

OVERALL

  • Oversee day-to-day departmental administration by coaching and motivating managerial staff and departmental personnel to make maximum use of experience and skills.
  • Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
  • Manage use of corporate funds through effective budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while achieving service levels.
  • Maintain effective working relationships across the enterprise.
  • Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ strategic goals.
  • Coordinate activities between multiple divisions to achieve desired results.
  • Support BCBSAZ’s Core Value of maintaining a heritage of service through community involvement.
  • 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.
  • Perform all other duties as assigned.

BCBSAZ 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.

Skills / Requirements

REQUIRED QUALIFICATIONS Required Work Experience[R1]  7 years of management experience 5 years of experience in the healthcare industry 5 years of experience in Inter-plan programs Required Education BA or BS degree in business administration or related field Required Licenses N/A Required Certifications N/A   PREFERRED QUALIFICATIONS Preferred Work Experience 10 years of management experience 7 years of experience in the healthcare industry 7 years of experience in Inter-plan programs 3 years of experience in developing short and long range strategic plans, forecasting, and budgeting Preferred Education BA or BS degree in business administration or related field Preferred Licenses N/A Preferred Certifications N/A REQUIRED COMPETENCIES[R1]  Required Job Skills Strong written and verbal communications. Intermediate knowledge of electronic data processing systems, technology, and applications. Intermediate PC proficiency. Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones. Intermediate skill in word processing, spreadsheet and database software. Intermediate skill using departmental BCBSAZ and BCBSA software. Required Professional Competencies Management skills in an operationally changing environment, with drive for results and success based on planned objectives. Expert knowledge of quality and cost-effective customer service. Expert knowledge of the principles and practices of healthcare prepayment. Expert customer service skills. Interpersonal skills that allow for harmonious relationships with providers, members and coworkers. Recognize strategic opportunities and use data to make timely and sound decisions. Flexibility and willingness to adjust to shifting demands/priorities. Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs. Required Leadership Experience and Competencies High standard of performance while pursuing aggressive goals Principled leadership and sound business ethics PREFERRED COMPETENCIES Preferred Job Skills N/A Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A    

Application Instructions

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