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.

For Internal Use Only*
Paygrade Levels: 25

Purpose of the Job 

Coordination of the Healthcare Effectiveness Data and Information Set (HEDIS®) Audit, roadmap preparation, data collection and reporting processes in addition to HEDIS intervention activities to improve related clinical performance measures for the FEP lines of business. Additionally, this position will take a supporting role in coordinating the efforts to improve and is responsible for coordination activities related to the HEDIS measures for FEP. In conjunction with the HEDIS coordinator will assisting serving as the liaison with Network Management, Health Services, Finance, Informatics, Federal Employee Program (FEP) and other ad hoc departments and programs as necessary.

Essential Job Functions & Responsibilities 

*     Actively demonstrates superior customer service to all internal and external contacts
*     Collects, monitors and analyzes data via call logs and other reports to proactively identify Members who may be experiencing dissatisfaction with the health plan services and benefits for outreach/intervention
*     Able to respond and troubleshoot with accuracy to pharmacy, benefits, eligibility and claims related questions or concerns for the Medicare line of business.  Maintains working knowledge of Medicare while adhering to health plan policies and procedures
*     Works with Member Services, Grievance and Appeals, Compliance, Care Management and other Departments to identify and outreach to Members who are at risk for dissatisfaction and disenrollment
*     Serves as a connection to Members and their families experiencing difficult, complex or chronic unresolved problems with the health plan benefits and services.  Works to bring the Member and their family whole and satisfied with services
*     Utilizes compassionate listening, research, problem solving and documentation of Member complaints and concerns that are identified through CTM and other Member touch points
*     Works cross-functionally with internal and external teams to ensure retention program outcomes and member satisfaction goals are met
*     May represents the health plan at external events, health fairs, new member orientations and other plan educational events
*     Able to clearly document in English Member interactions and interventions 
*     Conducts outbound call campaigns, surveys and other member focused interventions utilizing outbound call scripts and talking points
*     Supports Call Center Operations by answering inbound phone calls during call volume spikes
*     During off-line time, participate in cross training and provide back-up support for other Medicare operations functions as assigned
*     Reads and responds to department communications, actively participates in staff meetings and department activities that include process improvements or team building 
*     Maintains production levels as set by departmental goals
*     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.


1.    Required Work Experience
*     1 year of quality improvement experience
*     1 year of experience in analytics 
*     3 years of experience in healthcare industry 

2.    Required Education
*     High-School Diploma or GED in general field of study.

3.    Required Licenses
*     N/A
4.    Required Certifications
*     N/A

1.    Preferred Work Experience
*     4 years of experience in healthcare claim industry with a strong understanding of claims processing from either a provider/hospital point of view or from a payer’s point of view.
*     3 year of quality improvement experience
*     3 year of experience in analytics 
2.    Preferred Education
*     Associate Degree in general field of study
3.    Preferred Licenses
*     N/A
4.    Preferred Certifications
*     N/A


1.    Required Job Skills
*     N/A
2.    Required Professional Competencies
*     Independent decision-making ability, Displays Sound Judgment, Member Focused, Member Service, Verbal Communication, Written Documentation, Informing Others, Process Improvement, Complex Problem Solving, People Skills, Teamwork, People Management, Managing Processes, Emphasizing Excellence.
3.    Required Leadership Experience and Competencies
*     N/A

1.    Preferred Job Skills
*     N/A
2.    Preferred Professional Competencies
*     N/A

3.    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

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

Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona

Posted 9 Days Ago

Full time


Application Instructions

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