Operational Claims Performance Analyst (Remote)

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

Support the claims enterprise and claims administration business leaders in analyzing workflow, identifying gaps in current and future business processes, creating and implementing process improvements for the area, supporting and testing output, and building desired business requirement documents. This position will advocate for new ways of doing things based on data analysis and ongoing reporting. Bring to area management and best practices that can be evaluated and implemented. The individual will continuously review, research, conduct testing, and develop optimal data metrics and measures, resulting in

increased productivity and higher satisfaction. Participate in all types of release assessment, support new system discovery sessions, process maps, proactive analysis, and implementation. Communicate issues and assist with resolution.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 7 years of demonstrated experience in the healthcare or insurance field in the following areas:

· Business Analysis, including Business Requirements Documents and User Stories, Test Strategies, Test Criteria, Defects, etc.

· Data/Reporting Analysis using Excel, Access and Tableau,

· Process Improvement, including Business Process Engineering (Current State vs. Future State Analysis, Gap Analysis, and Workflow Diagrams)

· 3 years of performing quality audit functions in claims processing and business processes

2. Required Education

· High-School Diploma or GED in the general field of study

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

2. Preferred Work Experience

· 10 years of demonstrated experience in the healthcare or insurance field in four or more of the following areas:

· Business Analysis, including Business Requirements Documents and User Stories, Test Strategies, Test Criteria, Defects, etc.

· Data/Reporting Analysis using Excel, Tableau, Access, SQL, or SAS · Process Improvement, including Business Process Engineering (Current State vs. Future State Analysis, Gap Analysis, and Workflow Diagrams)

· Robotics Process Automation experience in the claim processing field. · 6 years of performing quality audit functions in claims processing and business processes

3. Preferred Education

· Associate degree in business or related field

4. Preferred Licenses

· N/A

5. Preferred Certifications

· Six Sigma Training

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

LEVEL I

· Support the claims administration enterprise in collaborating with the claims business team and technical writer team to develop, define, and redesign processes and procedures to resolve gaps within the processing systems

· Responsible for participation in various projects and cost reduction initiatives supporting individual, team, department, and organization goals.

· Coordinate identifying, prioritizing, and resolving business-related issues in various areas.

· Develop high-level steps for staff, vendor, and internal departments of any current/new systems for workflows within the Commercial Segment. Collaborate with the technical writing team to formalize and approve the documents for business teams.

· Ability to think outside the box and objectively and professionally challenge the status quo that engages others in constructive dialogue to achieve results. Builds and fosters good working relationships with internal customers and peer

· Responsible for responding to all email inquiries related to potential issues by analyzing, researching, and assessing requirements to resolve issues via creating serving blue tickets.

· Develop test script scenarios for RPA and business flows, validate the accuracy/desired outcome, and participate in all levels of testing for current and new system transformation before the production release.

· Monitor RPA output closely and work closely with the RPA team for optimized results.

· Escalate priority issues created when no response has been provided via serving blue.

· Evaluate and report incoming, ongoing, unresolved, and resolved Demand/Incident Tickets and system operations issues.

Report back to the business area and management on the workaround capabilities as necessary

· 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

LEVEL 2

· Review requirements, perform testing, and pre-production and post-production validation.

· Analyze and review test results with management to determine final acceptance.

· Evaluate alternatives to strategies and develop business contingency plans where necessary

· Perform root cause analysis to identify continuous process improvements and increase automation.

· Responsible for developing and reviewing Change Request Documents that support the current and future state with optimal results.

· Responsible for reviewing bulletin releases received by the Agile teams, analyzing impacts to the Operations area, and implementing plans to execute readiness.

· Responsible for developing and reviewing Business Decision Documents that support the current and future state with optimal results and resolve system deficiencies.

· Committed to data-driven performance analysis and analytical approach to managing metric performance.

· Responsible for communicating with senior management on risks, changes, and updates related to all system releases, including IPPT Releases and any software releases impacting the claims administration.

· Evaluate identified issues by researching the processing system interface/mappings and documenting the results and recommendations for the senior manager of Claims Enterprise Performance.

· Translate business needs into user requirements and collaborate with the technical team to document them for the claims administration and communicate those requirements as necessary.

· Six-Sigma Training and Certification completion

· Collaborate with internal teams to clearly understand workflows and processes. Analyze and define requirements through research, data gathering, and brainstorming activities.

· 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 duties in Level 1 and all other duties as assigned

LEVEL 3

· Leading as the spokesperson for claims administration on the desired outcome in process improvement mapping for future state process flows with minimum manual impacts on the business areas.

· Serve as the primary operational contact for internal and external customers when needed or in the absence of the Sr. Manager of Claims Enterprise Performance

· Proactively identify improvements based on trends or operations issues and work with teams, including claims administration leaders, to implement requirements as necessary.

· Develop and maintain effective communications and working relationships with departments, customers, vendors, staff, and outside organizations.

· Responsible for participating in and supporting the requirements and processes specific to Association Mandates that support the current and future state with optimal results.

· Communicate the BSBSAZ system and process changes to Sr. Manager of Claims Enterprise Performance

· Assist all levels of management in developing tactical and strategic ideas to support business goals.

· Create ad hoc reports as defined, perform analysis of data, and verify accuracy to ensure high performance.

· Administer, interpret, and maintain a working knowledge of the required BCBSAZ systems, procedures, forms, and manuals.

· Establish and maintain positive working relationships with internal and external teams.

· Ability to multitask complex reports, projects, and tasks as required by BCBSAZ or mandates.

· 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

· Back-up to Level 1-2 as needed

· Perform all other duties as assigned

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Strong written and verbal communication skills. Ability to craft professional, transparent, written communications.

· Experience in process management execution

· Intermediate skill in the use of office equipment, including copiers, fax machines, scanners, and telephones

· Advanced proficiency in spreadsheet, database, and word-processing software

· Strong organizational and planning skills

· Ability to perform systems research and analysis.

· Ability to write and present business documentation.

· Demonstrate advanced knowledge of and experience with developing business requirements, user acceptance testing, and their supporting toolsets.

· Demonstrated problem-solving skills.

· Ability to prioritize tasks and work with multiple priorities, sometimes under limited time constraints.

· Ability to analyze data and put it into an easy-to-digest format.

2. Required Professional Competencies

· Maintain confidentiality and privacy

· Perseverance in the face of resistance or setbacks

· The ability to interact professionally with diverse executives, managers, and subject matter experts.

· Effective interpersonal skills and ability to maintain positive working relationships with others.

· Strong knowledge of provider operating guide, group membership requirements, and BlueCard Policies and Procedures

· Ability to interpret BCBSA business requirements, Release Notes, functional specifications, and system use cases, including the Inter-Plan Policy/Provision/Medicare Advantage Policy/Provisions and Licensee Requirements, and ability to identify operational impacts

· Detail-oriented with the ability to question existing data parameters, definitions and data flows, then track an issue back to its source

· Analytical knowledge necessary to generate reports based on available data and then make recommendations and decisions based on reported data

· Document processes at a detailed level to make decisions based on data

· Establish and maintain working relationships in a collaborative team environment

· Basic project lead or project management skills

· Proficiency in process improvement

1. Required Leadership Experience and Competencies

· Presentation skills

· Foster and maintain a positive, productive, and collaborative work environment

· Advanced organizational skills and attention to detail

· Work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers

· Facilitate and resolve customer requests and inquiries for all levels of management within the Corporation.

PREFERRED COMPETENCIES

3. Preferred Job Skills

· Advanced PC proficiency and analytical skills

· Intermediate spreadsheet and database software skills. MS Excel skills critical to job function include professional formatting of content, importing and exporting data, using pivot tables, and creating charts and graphs when necessary

· Comprehensive knowledge of BlueCard Policies, Inter-Plan Programs Policies & Provisions, and Procedures

· Robust written and verbal communication skills, including presentations and public speaking skills

4. Preferred Professional Competencies

· Knowledge of a wide range of matters about the organization's operations

5. Preferred Leadership Experience and Competencies

· Lead process management tracking and execution

Our Commitment

AZ Blue 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.