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.

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

PURPOSE OF THE JOB

This position is responsible for overseeing a dedicated team of staff whose mission it is to continually increase Provider Servicing and electronic tool adoption. Work performed involves building and implementing processes to leverage technology and increase automation and efficiency, reduce administrative costs and improve SLAs. Leads a strong, efficient team of analytical and relationship building talent that ensures a positive Provider and Business experience.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

5 years of lead / supervisory experience or manager role

5 years of experience in business analysis, systems application, and operations

2. Required Education

· Bachelor’s Degree in Management, Business Administration, or experience in related field

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

7 years of lead / supervisory experience or manager

5 years of experience in business analysis, systems application, and operations

3 years of experience in developing short and long range strategic plans, forecasting, and budgeting

2. Preferred Education

· BA or BS degree in information systems, management, business administration or related field

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Partner with provider network and provider relations teams to address facility claims issues and determine resolutions and opportunities for process improvements to improve customer satisfaction and reduce administrative costs. · Conduct ongoing analysis on facility claims issues and identify common trends to assist in resolutions and improvements in processes, system platforms, SLAs, communication, etc.

· Partner with Finance team to address overpayment and recovery issues to determine opportunities for process improvements to reduce administrative costs, unsolicited/solicited refunds, returned checks, etc..

· Develop and implement processes and work flows for managing and resolving claim issues / rework requests received to ensure standardization, accuracy and efficiency.

· Develop reporting processes for conducting data analysis to identify trends and opportunities for improving existing processes and system platforms to lower administrative costs and improve customer satisfaction.

· Act as a facility liaison for the provider service outreach team to address facility claims issues, concerns and blockers.

· Develop and implement plans to increase provider self-service utilization. Identify opportunities to achieve administrative efficiencies while maintaining service and maximizing provider satisfaction.

· Monitor and improve existing finance metric reports to measure overpayment recovery performance and business impact.

· Develop and implement SLAs for resolving facility claims and completing any rework items.

· Develop and implement process for staff to report outstanding work issues, timelines and resolution.

· Develop and produce weekly status dashboard for leadership.

· Oversee day-to-day departmental administration by coaching, motivating staff and identify learning opportunities to make maximum use of experience and skills.

· Develop staffing plan to meet current needs

· Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Strong written and verbal communications.

· Intermediate PC proficiency.

· Intermediate skill in word processing, spreadsheet and database software.

· Intermediate skill using departmental BCBSAZ software, specifically claims processing and EDI applications.

2. Required Professional Competencies

· Management skills in an operationally changing environment, with drive for results and success based on planned objectives.

· Advanced analytical and diagnostic skills dealing with issues that are often novel and not readily defined, lack known precedent or appear contradictory.

· Flexibility and the ability to anticipate customer needs communicate them in a way that is consistent with business strategy.

· Ability to Influence business leaders and educate providers.

· Ability to create new approaches to leverage technology from abstract information.

· 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.

3. Required Leadership Experience and Competencies

· High standard of performance while pursuing aggressive goals

· Principled leadership and sound business ethics

PREFERRED COMPETENCIES

1. Preferred Job Skills

· N/A

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

CORPORATE RESPONSIBILITIES

Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications and Quality Management Accountabilities.

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!

Apply Online