Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ offers 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.

 

ESSENTIAL job functions AND RESPONSIBILITIES

Level 1

  • Process applications received in various formats within established time-frames to adhere to CMS guidelines.
  • Identify, research, process, resolve and respond to customer as it relates to incomplete applications
  • 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
  • Perform demographic maintenance received from various sources
  • Monitor and review notifications generated from erred electronic files
  • Review and process disenrollment request

Level 2

  • Resolve billing and eligibility discrepancies and communicate with customer as appropriate
  • Reconcile monthly payments received, identify out of balance conditions and when a refund in necessary
  • Reconcile daily TRR file from CMS and ensure appropriate letter is scheduled
  • Monitor, process and resolve timers such as out of area, late enrollment penalty and pending applications
  • Mentor and train level 1 employees

Level 3

  • Reconcile monthly membership report as well as the prescription drug edit report
  • Submit monthly enrollment data validation
  • Process late enrollment penalty appeal response from Maximus
  • Perform model office testing on system enhancements and projects
  • Mentor and train level 1 and 2 employees

Level 4 - Performs functions in a lead capacity

  • Perform standard comparison reporting to identify discrepancies between systems
  • Update and review any department documentation
  • Coach and mentor as errors are identified through the auditing process
  • Consult and coordinate with various entities to obtain information and ensure resolution of customer inquiries or retro-request.
  • Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedure, forms and manuals.
  • Train employees on multiple functions

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

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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