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 1,400 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.

Responsible for internal and external functions that support accurate claim processing for medications.

LEVEL 1 – PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW

  • Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
  • Support internal and external customers with information on benefits applicable to medication claims
  • Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
  • Communicate recommendations in regard to medication claim processing and benefit decisions.
  • Monitor and investigate reported plan set up system issues
  • Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
  • Resolve escalated member issues
  • Research & provide recommendations for accumulations issues
  • Logs all benefit setup issues on error tracking reports
  • Provide monthly updates on error resolutions and impact reports

 

LEVEL 2 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION

  • Communicates issues identified within vendor system effectively to team.
  • Communicates issues identified within plan setup testing or other escalated research to team
  • Strategizes solutions for issue resolution and communicates plans to team.
  • Provides written documentation for desk levels.
  • Provides support to other team members when necessary
  • Review plan testing documents for minimal accuracy

 

LEVEL 3 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON;  ACTS AS SUBJECT MATTER EXPERT

  • Primary liaison for Pharmacy Management for applicable benefit design questions
  • Primary SME contact for various internal departments within BCBSAZ In regards to pharmacy plan setup and design
  • Builds reporting and analyzes data for benefit recommendations to management.
  • Review and determine pharmacy benefit setup upon renewal for all benefit plans
  • Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays
  • Submit drug code assignments to enrollment for all benefit plansMaintain pharmacy drug code matrix

ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
  • Properly track all pharmacy benefit issues & concerns
  • 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.

Skills / Requirements

Required Work Experience Level 1 Level 2 Level  3     3 years 5 years 5 years   Experience in pharmacy or medical field 1 year 3 years 5 years   Experience in prescription benefit administration   1 year 2 years   Experience working in vendor applications (rebate, web tools, formulary tools)         Experience in progressive responsibility with allocation of resources and participating in management of complex projects     Required Education High-School Diploma or GED Preferred Work Experience Level 1 Level 2 Level 3     3 years 3 years 5 years   Experience with a pharmacy benefit management  or prescription claim administration 1 year 1 year 2 years   Experience with the current BCBSAZ PBM system   1 year 2 years   Experience with BCBSAZ claims software / systems 2 years 3 years 4 years   Demonstrated experience handling confidential information     5 years   Demonstrated experience handling vendor system coding and analytic functions         Demonstrated experience handling complex projects and allocation of resources     Preferred Education Associate’s degree in general  field of study Required Job Skills Intermediate PC proficiency with word processing, spreadsheets,  and claims and imaging software (Level 1) Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels) Advanced PC proficiency, including spreadsheet  and vendor application software (Levels 2 and 3) Required Professional Competencies Take initiative Establish and maintain working relationships in a collaborative team environment Flexibility in prioritization of workflow Compose a variety of business correspondence Required Leadership Experience and Competencies Make use of employees' skills and abilities to deliver business objectives Use available information to focus the team's activities and identify priorities  

Application Instructions

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