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.

 Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.  Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.

  • Assist with the development and review of l key workflows, policies and procedures and job aids at least annually. Under the direction of the Manager, Medical Review, updates/revises workflows, policies and procedures and job aids as needed.
  • Assist with assigning work queues and oversight for key performance indicators
  • Oversee day-to-day activities, including inventory management to meet departmental and corporate timeliness standards
  • Assist with improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations
  • Maintain a thorough knowledge of evidence-based criteria and other policies
  • Assist with the validation and confirmation of follow through of the medical review decisions.
  • Assist with the development, execution and evaluation of desk level procedures and job aids
  • Assist with the reviewing, updating and accurate documentation, computer files, policies and procedures related to the departmental goals and objectives.
  • Assist with maintaining all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
  • Assist with the implementation of quality assurance process, procedures, and measure for team activities.
  • Assist with providing motivation and encouragement to team.
  • Assist with interviews and candidate selection
  • This position requires a full-time work schedule
  • Performs all other duties as assigned

Assist leadership with deployment of strategic initiatives and Perceptyx plan.

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 5 years of experience in clinical field of practice, health insurance or other health care related field Required Education Associate’s Degree or Diploma in Nursing Required Licenses Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN) current, and unrestricted State of Registered Nurse license Preferred Work Experience 3 years of experience in  clinical field of practice, health insurance, or other health care related field 1 years of experience in a lead role Preferred Education Bachelor's Degree in Nursing or business related field of study Master’s Degree in Nursing or business related field of study Required Job Skills Strong written and verbal communications. Excellent organizational skills and strong attention to detail Possess proficient computer and technological skills especially Word, Excel, PowerPoint, SharePoint, Lync/Webinar, Internet and telephone including voice over internet protocol (VoIP) Intermediate skill in use of office equipment, including copiers, fax machines, scanners Intermediate skill in word processing, spreadsheet and database software Ability to gather, analyze data and prepare informative and accurate business reports Required Professional Competencies Maintain confidentiality and privacy Ability to set priorities 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 Demonstrates ability to identify gaps, communicate gaps and propose possible solutions to close gaps to leadership Ability to motivate, coordinate and collaborate effectively with team and stakeholders from multiple business areas 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.  Resource management skills Leadership  skills Ability to empower employees and encourage innovation and risk taking   The maturity, communication and influencing skills to assume a lead role in a growing, and changing organization. Mindset geared toward the creation, execution and continuous improvement.  

Application Instructions

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