Quality Service Tech- Operational Excellence
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
• Perform quality audits for all aspects of the work that has been outsourced to a Vendor, including but not limited to the telephone, claims, correspondence, and Data Capture, to ensure that work performed for our Customers is complete and accurate.
• Scope of the position includes accountabilities that support the following programs: 1. Claims and Correspondence Data Capture, 2. Processing of Claims, 3. Provider Calls
Essential Job Functions & Responsibilities
• Perform, evaluate, and assist in defining and improving the quality standards to achieve individual and department performance goals as defined within the department guidelines.
• Keep status of the unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
• Conduct telephone, claim, and Data Capture Audits for claims and correspondence audits for one or more Vendors, in accordance with department, company, and association guidelines, and enter findings into the quality tracking system.and/or Vendor’s Tracking tool.
• Track, analyze, and report findings to appropriate Vendor, Reporting Auditor, and Department Leadership.
• Investigate computer system issues/programming issues.
• Travel to offices located through out the state as needed.
• Perform departmental training and Calibration meetings as needed within Department
• Performs Vendor training and bi-weekly Monthly Calibration meetings with Vendors.
• Self-motivated and able to work with minimal direction and exercise sound judgment
• Effective interpersonal skills and ability to maintain positive working relationship with others
• Ability to interpret Service Level Agreements within an Exulted Contract with Vendor and audit according to quality and quantity of contract.
• Respond and Maintain Service Level Agreement for Multiple Proxy boxes within the Department
• Verbal and Written Communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts
• Work closely with Vendor Analyst to research, develop and enter CSRs with Vendor, Serving Blue tickets, test changes and reports results to maintain continuity in reporting for system enhancements, releases and upgrades
• Ability to work closely with Claims Management, IT and other department personnel within the Corporation and maintain effective and cooperative relationship with all levels of Plan and BPO personnel Managed projects
• 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
1. Required Work Experience
• 3 year(s) of experience in Health Care production field or auditing of work completed field
2. Required Education
• High-School Diploma or GED in general field of study
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
• 5 year(s) of experience in claim examination, health insurance, customer service call center, medical office, or other healthcare-related field
2. Preferred Education
• Associate's Degree in general field of study
3. Preferred Licenses
• A valid Arizona driver license with an acceptable driving record, if travel is required (e.g. regional offices)
4. Preferred Certifications
1. Required Job Skills
• Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones
• Intermediate PC proficiency
• Intermediate skill in word processing, spreadsheet and database software
2. Required Professional Competencies
• Maintain confidentiality and privacy
• Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
• Capable of investigative and analytical research
• Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
• Establish and maintain working relationships in a collaborative team environment
3. Required Leadership Experience and Competencies
• Ability to take appropriate risk, using available data
• Ability to build synergy and interdependence with a diverse team, in a changing environment
1. Preferred Job Skills
2. Preferred Professional Competencies
3. Preferred Leadership Experience and Competencies