Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers 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

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

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

  • Level 1 - 3 years’ experience in pharmacy or medical field AND 1 year experience in prescription benefit administration
  • Level 2 - 5 years’ experience in pharmacy or medical field AND 3 years’ experience in prescription benefit administration AND 1 year experience working in vendor applications (rebate, web tools, formulary tools)
  • Level 3 - 5 years’ experience in pharmacy or medical field AND 5 years’ experience in prescription benefit administration AND 2 years’ experience working in vendor applications (rebate, web tools, formulary tools)
  • Level 4 - 6 years’ experience in pharmacy or medical field AND 6 years’ experience in prescription benefit administration AND 5 years’ experience working in vendor applications (rebate, web tools, formulary tools) AND 5 years’ experience in progressive responsibility with allocation of resources and participating in management of complex projects

Required Education

  • High-School Diploma or GED

Required Licenses

  • N/A

Required Certifications

  • N/A
 

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • Level 1 - 3 years’ experience in pharmacy benefit management or prescription claim administration AND 1 year experience with the current BCBSAZ PBM system AND 2 years’ demonstrated experience handling confidential information
  • Level 2 - 3 years’ experience in pharmacy benefit management or prescription claim administration AND 1 year experience with the current BCBSAZ PBM system AND 1 year experience with BCBSAZ claims software/systems AND 3 years’ demonstrated experience handling confidential information
  • Level 3 - 5 years’ experience in pharmacy benefit management or prescription claim administration AND 2 years’ experience with the current BCBSAZ PBM system AND 2 years’ experience with BCBSAZ claims software/systems AND 4 years’ demonstrated experience handling confidential information AND 5 years’ demonstrated experience handling vendor system coding and analytic functions
  • Level 4 - 6 years’ experience in pharmacy benefit management or prescription claim administration AND 6 years’ experience with the current BCBSAZ PBM system AND 6 years’ experience with BCBSAZ claims software/systems AND 6 years’ demonstrated experience handling confidential information AND 5 years’ demonstrated experience handling vendor system coding and analytic functions AND 5 years demonstrated experience handling complex projects and allocation of resources

Preferred Education

  • Associate’s degree in general field of study

Preferred Licenses

  • N/A

Preferred Certifications

  • N/A

 

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
 

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 medication related 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.

LEVEL 2 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION

  • Communicates issues identified within vendor system effectively 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

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

  • Primary liaison for Pharmacy Management for applicable vendor applications.
  • Primary SME contact for various internal departments within BCBSAZ.
  • Builds reporting and analyzes data for benefit recommendations to management.

LEVEL 4 - LEAD - PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION

  • Works with Pharmacy Management Leadership team to identify project prioritization
  • Allocates resources to ensure required work is accomplished within defined time frames
  • Assigns Tasks to Analysts and Support Specialists as needed
     

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.

COMPETENCIES

REQUIRED COMPETENCIES

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

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced PC proficiency with word processing, spreadsheets, and claims and imaging software (Levels 2 - 3)

Preferred Professional Competencies

  • Effective interpersonal communication
  • Multicultural sensitivity
  • Claim system experience with pharmacy vendor software and/or systems (Levels 2 - 3)

Preferred Leadership Experience and Competencies

  • N/A
     

Our Commitment

AZ Blue 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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