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.

Purpose of the job

  • Provide strategic analysis that influences business decisions, improves efficiency and drives innovation.  Extract and aggregate claims data from various sources.  Execute complex claims data analysis that guide the detection, prevention and deterrence of waste and abuse; and that guide the development of medical coverage guidelines, reimbursement policies, risk assessments and other medical cost containment solutions.   Prepare summary findings and recommendations into investigative reports. 
 

ESSENTIAL job functions AND RESPONSIBILITIES

 

Level 1

  • Identify, analyze, interpret and validate healthcare data metrics, , waste and abuse trends and patterns
  • Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis directed toward the prevention, detection and deterrence of, waste and abuse
  • Create, modify, maintain, and enhance existing programming or business processes associated with specific responsibilities
  • Interpret, communicate, and present results to all levels of management in consistent and easy to understand formats to facilitate fact-based decision-making
  • Complete projects within preset timelines and report status to supervisor and project manager
  • Prepare written documentation on projects to provide a peer review trial and ensure continuity and integrity
  • Build and maintain close working relationships with internal stakeholders and key external client contacts (e.g. Providers, Internal Clinicians, Vendors, Customers, BCBS Association, Blue Plans, Auditors and all local, state and governments agencies
  • Develop processes, write queries and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions
  • Model financial impact analysis for trends and schemes identified
  • Collaborate with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards
  • Manage, manipulate and mine data to respond to various requests for reporting purposes as well as identify waste and abuse trends and perform root cause analysis and further refine reports to reflect irregularities/aberrations.
  • Perform moderately complex data analysis techniques in in the determination of the existence of, waste and abuse schemes.

Level 2

  • Perform complex analysis and interpret complex calculations to recommend actions and solutions
  • Develop financial models needed to accomplish analytic goals
  • Serve as a subject matter expert for internal stakeholders
  • Make sound assumptions and fact-based recommendations and discuss with supervisor, manager, or project manager
  • Effectively communicate results and recommendations to internal and external customers
  • Provide self and peer review of job responsibilities
  • Share knowledge of skills, projects, and business needs with peers and less-experience analysts.  Train new analysts
  • Report to a supervisor or manager who provides general supervisory instructions, manages projects and review results.  Develop own work-plan, and discusses timelines, prioritization, and objectives with supervisor or manager.

Level 3

  • Drive and implement complex and critical analytic initiatives with minimal oversight
  • Create and research analysis and recommendations, which help, achieve corporate initiatives and goals
  • Review results –post-implementation to ensure projections are realized and recommend modifications as applicable
  • Produce complex analytic solutions and consolidate complex analytics into easy to understand presentations focused on business implications
  • Plan and lead complex analytic project from inception to completion.  Includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementation the project and resolving/monitoring post-implementation issues
  • Communicate (both verbally and in writing) and interpret results, recommendation and abstract concepts to internal and external customer.  Anticipate and address possible customer questions and concerns
  • Incorporate strategic planning in all areas of responsibility
  • Train and mentor other analysts

ALL LEVELS

  • 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.

 

 

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.



Qualifications

REQUIRED QUALIFICATIONS

  1. Required Work Experience
  • 1 year of experience in data analysis using analytic tools and processes working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology (level 1)
  • 3 years of experience in data analysis using analytic tools and processes, working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology (level 2)
  • 5 years of experience in data analysis using analytic tools and processes working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology (level 3)
  1. Required Education
  • Bachelor's Degree in mathematics, statistics, business, or related field of study (Applies to All Levels)
  1. Required Licenses
  1. Required Certifications
 

 

 

PREFERRED QUALIFICATIONS

  1. Preferred Work Experience
    • 2 year of experience in data analysis using analytic tools and processes working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology (level 1)
    • 4 years of experience in data analysis using analytic tools and processes working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology, including development of business analytics and financial impact analysis (level 2)
    • 6 years of experience in data analysis using analytic tools and processes working for a healthcare organization / health insurer / investigative industry and knowledgeable in medical coding and medical terminology, including development of business analytics and financial impact analysis (level 3)
  1. Preferred Education
    • Master’s Degree in mathematics, statistics, business, or related field of study. (Applies to All Levels)
  1. Preferred Licenses
    • N/A
  1. Preferred Certifications
  • CFE, AHFI, CPA, CPC
 

competencies

REQUIRED COMPETENCIES

  1. Required Job Skills (Applies to All Levels)
    • Intermediate PC proficiency
    • Intermediate proficiency in database, presentation, spreadsheet and word processing software
    • General proficiency in mathematical concepts
    • Intermediate understanding of data management principles
    • Advanced analytical and problem solving skills with demonstrated experience conducting research, locating and extracting appropriate enterprise-wide data from databases, developing business intelligence reports, analyzing and interpreting data, and providing summary report recommendations
    • Intermediate proficiency in computer programming, including SAS and other business intelligence programs
    • Intermediate skill with SAS/SQL programming (Applies to Levels 2 – 3)
    • Advanced understanding of data management principles (Level 3)
    • Proficiency in SAS Enterprise Business Intelligence software (Level 3)
    • Intermediate skill with data visualization tools, such as Tableau (Level 3)
  1. Required Professional Competencies (Applies to All Levels)
    • General knowledge of the healthcare industry
    • Broad understanding of medical terminology, coding, provider contracts, medical coverage guidelines and pricing policies
    • Analytical knowledge necessary to generate analytic solutions
    • Ability to solve problems independently and draw accurate conclusions from data using basic analytic techniques
    • 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              
  1. Required Leadership Experience and Competencies (Applies to All Levels)
  • N/A

PREFERRED COMPETENCIES

  1. Preferred Job Skills (Applies to All Levels)
    • Advanced proficiency in spreadsheet, database and word processing software
    • Intermediate proficiency with data warehouses and query tools / design
    • Intermediate skill with data visualization tools, such as Tableau
    • Intermediate proficiency with development, testing, and management of Tableau Dashboards
    • Intermediate understanding of data management principles
    • Advanced skill in database, spreadsheet, business intelligence, statistical, and data cubing software
    • Advanced skill in mathematics and statistics
    • Intermediate proficiency in computer programming, including SAS and other business intelligence programs
    • Proficiency in SAS Enterprise Business Intelligence software
    • Advanced understanding of data management principles
    • Intermediate skills with SAS/SQL programming (Applies to Levels 2-3)
    • Proficiency in SAS enterprise Business Intelligence software (Level 3)
    • Intermediate skill with data visualization tools, such as Tableau (Level 3)
    • Advanced skills in mathematics and statistics (applies to Levels 2-3)
    • Advanced understanding of data management principles (Level 3)
  1. Preferred Professional Competencies (Applies to All Levels)
    • Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status
  1. Preferred Leadership Experience and Competencies (Applies to All Levels)
  • 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
 

Application Instructions

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