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.


Required Work Experience

  • College-level coursework related to Software, Business or other related field.

Required Education

  • High School Diploma or GED in general field of study
  • Two years attendance at accredited school pursuing a Bachelor’s Degree in Business, Accounting or other related field.


  • Experience working in SIU or software related experience

Preferred Education

  • Bachelor's Degree in related field of study


  • Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those 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.


Required Job Skills

  • Intermediate PC proficiency
  • Classroom knowledge or work experience of Excel and Word is a priority
  • Analytical and problem solving skills with demonstrated experience conducting research, locating and extracting appropriate data from databases, analyzing and interpreting data, and providing summary report recommendations

Required Professional Competencies

  • General knowledge of the healthcare industry
  • Ability to solve problems independently and draw accurate conclusions
  • Ability to deal with ambiguity and make recommendations with less than complete or conflicting information
  • Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
  • Ability to maintain confidentiality and privacy
  • Ability to communicate effectively, both orally and in writing, to all levels in all departments
  • Ability to distill and communicate financial levers and impacts to non-technical audiences
  • Ability to build and maintain productive working relationships with others
  • Proactive about requesting enough information to fully understand and meet the business need              


Preferred Job Skills

  • Advanced proficiency in spreadsheet, and word processing software
  • Intermediate proficiency with data warehouses
  • Intermediate skill and proficiency with data visualization tools, such as Tableau

Preferred Professional Competencies

  • Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status

Preferred Leadership Experience and Competencies

  • Ability to engage and collaborate with team members and business stakeholders at all levels of the organization
  • Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
  • High standard of performance while pursuing aggressive goals
  • Principled leadership and sound business ethics

Using claim data, analyze professional, facility, pharmacy, and dental models to build profiles on providers, members and pharmacies potentially participating in fraud, waste or abuse.  Performs complex data retrieval based on outlier analysis, change-score analysis, pattern analysis and rules analysis to calculate potential loss and prioritize caseload for investigators.  Researches and prepares business documents to include summaries of medical and payment policies for use by Investigators.  Compiles findings and recommendations that guide the development of medical coverage guidelines, reimbursement policies, risk assessments and other medical cost containment solutions into investigative reports.   This role also supports the SIU in development, validation and investigations of fraud, waste, and abuse matters.  On occasion may accompany Investigators on interviews of subjects and key witnesses as well as performs other investigative duties as necessary or appropriate to the position.

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  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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