Job Description

Awarded the Best Place to Work 2021, 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.

This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

This remote work opportunity requires residency, and work to be performed, within the State of Arizona

About the Job

Performs reporting, analysis and complex processing on on-exchange membership inbound files to ensure records between the FFM and BCBSAZ are in sync

Purpose of the job

  • Performs enrollment and eligibility review and processing with minor inbound customer service calls on Individual accounts. Performs review and reconciliation of accounts receivables on Individual accounts.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

  • 1 years of experience in health insurance, customer service, call center, medical office, or other healthcare-related field
  • 1 year(s) of experience in health insurance or other healthcare-related field (Applies to All Levels)

Required Education

  • High-School Diploma or GED in general field of study (Applies to All Levels)

Required Licenses

  • N/A

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • 2 years of experience in health insurance, customer service, call center, medical office, or other healthcare-related field
  • 1 year of ACA/On Exchange health insurance experience
  • 1 year of experience as an Enrollment/Eligibility Specialist (Applies to Level 2)
  • 1 year(s) of experience in bookkeeping/accounting field (Applies to Levels 2 - 3)
  • 1 year of experience as a reconciliation technician managing receivables, generating refunds, reconciling customer payments and generating reporting (Applies to level 4)

Preferred Education

  • Associate's Degree in Accounting field of study (Applies to Levels 2 - 3)

Preferred Licenses

  • N/A

Preferred Certifications

  • N/A

ESSENTIAL job functions AND RESPONSIBILITIES

Level 1

  • Process eligibility received in various formats within applicable processing systems within established time frames to adhere to corporate and performance guarantee guidelines.
  • Interpret various forms of subscriber remittances and reconcile payments to the accounts receivable.
  • Identify discrepancies and appropriately communicate to customer as necessary.
  • Reconcile monthly payments received, identify out of balance conditions and generate appropriate notification to customers.
  • Monitor and balance all general ledger transactions within department standards.
  • Answer calls from subscribers, and brokers regarding eligibility and/or accounts receivable status
  • Explain to customers a variety of information concerning the organization’s services, including, but not limited to rates, benefits, changes in coverage, eligibility, BCBSAZ programs etc.,
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and system.

Levels 2, 3 & 4

  • Mentor and train level 1 employees
  • Perform cross training within department
  • Monitor and review notifications generated from erred electronic files.
  • Develop skillset to support with resolving FFM HICS transactions and CMS member reconciliations (Level 2)
  • Demonstrate high degree of expertise in resolving FFM HICS transaction and CMS member reconciliations (Level 3)
  • Reconcile monthly payments received, identify out of balance conditions and generate appropriate notifications to customers.
  • Consult and coordinate with various entities to obtain information and ensure resolution of customer inquiries.
  • Document and record facts in regard to inquiries and correspondence by updating BCBSAZ files and systems.
  • Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
  • Coach and mentor as errors are identified through the auditing process. 
  • Represent division on cross functional projects and teams.
  • Update and review reviewing any department documentation.
  • Accept and resolve elevated customer inquiries.

ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels.
  • 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.

competencies

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate skill in use of office equipment, including copier, fax machines, scanner and telephones (All Levels)
  • Intermediate PC proficiency (Applies to All Levels)
  • Intermediate proficienty in spreadsheet, database and word processing software (Applies to All Levels)
  • Type >35 words per minute with 5% error rate or less (Applies to All Levels)

Required Professional Competencies

  • Maintain confidentiality and privacy (Applies to All Levels)
  • Capable of analytical research (Applies to All Levels)
  • Interpret and translate policies, procedures, programs and guidelines (Applies to All Levels)
  • Follow and accept instruction and direction (Applies to All Levels)
  • Practice interpersonal and active listening and communication skills to achieve customer satisfaction and departmental communication standards (Applies to All Levels)
  • Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
  • Navigate, gather, input and maintain data records in multiple system applications. (Applies to All Levels)
  • Prioritize, organize and self-manage workload in a hgh volume department (Applies to All Levels)

Required Leadership Experience and Competencies

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced knowledge of enrollment and eligibilty processing
  • Advanced knowledge of spreadsheet software (Applies to Level 2)
  • Knowledge of electrionic 834 files (Applies to Level 2)

Preferred Professional Competencies

  • Knowledge of a wide range of matters pertaining to the organization's service operations. (Applies to All Levels)

Preferred Leadership Experience and Competencies

  • N/A

Our Commitment

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.

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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