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: 24

Purpose of the Job 

The HEDIS Health Advocate is responsible for initiating interventions to ensure Member Service goals are achieved. This highly visible position will resolve complex member issues under the direction FEP Director, ensuring members are made whole and satisfied with services. Conducts performance interventions, strategies and outbound call campaigns based on data to improve CAHPS & HEDIS and other health plan satisfaction scores.

Essential Job Functions & Responsibilities 

*     Conduct outbound educational telephone calls to engage members/providers on HEDIS and MTM related topics as well as tracking outcomes/results of outreach
*     Advocate for the at risk member and thereby responsible for collaborating with internal departments as well as providers to ensure the member’s health, social and mental needs are met
*     Responsible for ongoing monthly outreach to providers for medical record requests to support supplemental data submissions including follow up calls when necessary to obtain needed medical record requests
*     Serve as periodic liaison between medical offices and FEPDO when offices are non-responsive or slow to respond to medical record requests
*     Collaborate with providers, including delegated provider partner entities and provider office quality/performance improvement staff to improve HEDIS metrics and scores
*     Develop and maintain a document of community resources for FEP staff
*     Review HEDIS Alerts/CCP Reports for HEDIS and MTM to determine outreach needs 
*     Provide consultation with members based on gaps in care in order to refer to the appropriate health programs
*     Collaborate with internal teams in coordination/participation of health and wellness events  
*     Responsible for HEDIS related annual updates to Customer Service documents
*     Encourage and motivate members to become compliant by educating on the importance of preventive services, scheduling appointments and coordinating needed appointments
*     Collaborate with appropriate teams to address barriers such as, but not limited to, transportation, housing and financial needs
*     Address and educate on HEDIS measures
*     Be knowledgeable of member materials (written, website, and Social Media) and order materials when necessary
*     Be knowledgeable of claims billing guidelines and health plan standards 
*     Utilize member engagement techniques and offer incentives as applicable
*     Be aware of physical and behavioral trauma triggers and act to engage appropriate staff


1.    Required Work Experience
*     2 years as a practicing licensed LPN in good standing
*     1 year of population health experience
2.    Required Education
*     High-School Diploma or GED in general field of study
*     Completed accredited practical nursing certificate program 
3.    Required Licenses
*     Current AZ LPN License 
4.    Required Certifications
*     N/A
1.    Preferred Work Experience
*     5 years as a practicing licensed LPN in good standing
*     3 year of population health experience or equivalent
*     1 year in care management or case management
2.    Preferred Education
*     Some college or undergraduate degree
3.    Preferred Licenses
* ??   N/A
4.    Preferred Certifications
*     N/A


1.    Required Job Skills 
*     Intermediate Microsoft Office skills - Word, Excel, and PowerPoint
*     Intermediate written and verbal communication skills
2.    Required Professional Competencies
*     Maintain confidentiality and privacy 
*     Support a positive professional work environment 
*     Experience managing multiple tasks concurrently
*     Ability to complete tasks timely and independently
*     Ability to monitor and track outcomes
*     Translate daily work into overall team goals and objectives
*     Able to identify, mitigate or resolve challenging situations with management involvement 
*     Able to see opportunities to improve processes and recommend changes 
*     Work effectively with staff from all divisions
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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