Job Description

Awarded the Best Place to Work 2021, 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.

The remote work opportunity requires residency, and work to be performed within the State of Arizona.

PURPOSE OF THE JOB

Perform quality audits for all aspects of the customer service position, including but not limited to the telephone, claims, and correspondence to ensure that information given to customers is complete and accurate. Scope of the position includes accountabilities that support the following programs utilization management, member relations, and network management.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 3 year(s) of experience in claims and customer service field

2. Required Education

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

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

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

· N/A

ESSENTIAL JOB FUNCTIONS AND 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 correspondence audits for one or more departments, in accordance with department, company, and association guidelines and enter findings into quality tracking system.

· Track, analyze, and report findings to appropriate parties, per departmental standards and guidelines.

· Investigate computer system issues/programming issues.

· Travel to offices located through out the state as needed.

· Perform departmental training or in-service meetings as needed.

· Utilization Management-related accountabilities for FEP staff include: - Review of healthcare service requests for completeness of information - Collection and/or transfer of non-clinical data

· Utilization Management-related accountabilities for Provider Assistance staff include: - Review of healthcare service requests for completeness of information - Collection and/or transfer of non-clinical data - Collection of defined clinical data using structured scripts or tools - Activities that do not require interpretation of clinical information or decisions regarding utilization of any clinical criteria for handling of a request for healthcare services or treatment

· 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

REQUIRED COMPETENCIES

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

PREFERRED COMPETENCIES

1. Preferred Job Skills

· N/A

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

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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