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.

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

PURPOSE OF THE JOB 

  • Establish a set of key performance metrics to measure and drive reliable, quality and efficient operational performanceResponsible for claims quality and compliance for the Company.  Accountable for claims configuration, efficiency, and adjudication.   Represents claims and operations with external and internal constituents. 

  • Lead migration activities for claims, enrollment, billing & fulfillment. Oversees business analysis and requirements development for new and existing core business systems. Collaborates with Information Technology to ensure quality delivery of business requirements.  

  • Develop strategic views of future state insurance operations, building roadmaps to capture efficiencies and remove redundancies.Support digital transformation by ensuring data and requirements contemplate self service opportunities. 

QUALIFICATIONS 

REQUIRED QUALIFICATIONS 

Required Work Experience 

  • 10 years in operations leadership including clinical, claims and enrollment business processes 

  • 10 years of experience in business/systems analysis, technical implementations, and implementing corporate projects 

  • 5 years of client implementation management experience 

  • 5 years of leadership of large organizations   

  • 5 years of experience in generating, selecting and implementing solutions to improve process performance. 

  • 3 years of experience in project management and process improvement 

  • 3 years of experience in developing short and long range strategic plans, forecasting, and budgeting 

Required Education 

  • Bachelor’s Degree in business administration, CIS, information technology, or related field 

Required Licenses 

  • N/A 

Required Certifications 

  • N/A 

 

PREFERRED QUALIFICATIONS 

Preferred Work Experience 

  • 13 years of experience in process management and business architecture development 

  • 13 years of experience in business/systems analysis, technical implementations, and implementing corporate projects 

  • 7 years of management experience 

  • 7 years of client implementation management experience  

  • 7 years of experience in generating, selecting and implementing solutions to improve process performance. 

  • 5 years of experience in project management and process improvement 

  • 5 years of experience in developing short and long range strategic plans, forecasting, and budgeting 

 

Preferred Education 

  • Master’s degree in business administration or related field 

Preferred Licenses 

  • N/A 

Preferred Certifications 

  • Six Sigma Black Belt preferred 

 

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES 

 

  • Develop and execute a strategic roadmap for migrating clients from legacy business systems to Velocity and future state digital tools 

  • Lead claims operations to keep claims inventories within expected volumes across all segments. 

  • Establish staffing plans for segments to ensure consistent throughput of claims, adjustments, and correspondence. 

  • Oversee building business intelligence tools to analyze claims and enrollment operations in support of segment operations. 

  • Lead development of tools to measure track and report performance of key business metrics through digital dashboards 

  • Represents the Company with regulators, the Association and other external constituents related to core business processes. 

  • Ensure the Advancement Office, Pit Crew, and Production Support teams operate effectively to minimize system issues that impact business processes.  

  • Support client and product implementations by working with segment leadership to drive timely and efficient system delivery. 

  • Develop strategies to increase operational performance, enhance claims quality, business process redesign, workflow management, process integration and improvement. 

  • Develop strategies to increase operational performance, enhance quality of services, business process redesign, workflow management, process integration and improvement. 

  • Provide direction for business sponsors and leaders for key corporate investments in business case development and planning, to enable effective operations. 

  • Conduct assessments of core business processes within the organization and proactively work with business leaders to strengthen process approaches and identify strategic improvement goals. 

  • Advise management teams on how to change their business processes, systems, and infrastructure to ensure adoption of operational excellence and completion of process improvement projects. 

  • Oversee application of business architecture development and process improvement including data analysis and decision making based on fact.  Promote the use of data analysis and fact based decision-making. 

  • Review and consult on design and content of all projects to ensure consistency across platforms, efficiency and lack of redundancy, appropriateness of statistical analysis, and relevance to business and strategic objectives. 

  • Work with business leaders and functional managers to drive operational excellence themes to successful completion. 

  • Lead cross functional teams to drive operational excellence, specifically in regards to the quality methodology, technical mentoring and business process coaching. 

  • Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service. 

  • Integrate change management protocols to maximize benefit and alleviate unnecessary disruption in the organization. 

  • Create a business process outsourcing strategy and execution plan for the Company 

  • Strategize with teams to create business cases required for outsourcing decisions for the Company 

  • Oversee team that develops sourcing and contracting efforts in support of our BPO strategy. 

  • Develop strong working relationships with key internal stakeholders to support business growth, process efficiency and enable expense reductions.  

  • Ensure teams managing day-to-day outsource operations keep business metrics within expectations. 

  • Identify value-added supplier partnerships that will minimize cost and maximize quality collaboration with operational managers to gather and understand business unit requirements; develop effective sourcing strategies to meet or exceed requirements. 

  • Perform all other duties as assigned. 

 

 

COMPETENCIES 

REQUIRED COMPETENCIES 

Required Job Skills 

  • Strong written and verbal communications. 

  • Intermediate PC proficiency. 

  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones. 

  • Intermediate skill using departmental BCBSAZ and BCBSA software. 

Required Professional Competencies 

  • Collaborative leader that is comfortable working in a matrixed organization, leading activities and teams that do not directly report to this position. 

  • Leadership skills in an operationally changing environment, with drive for results and success based on planned objectives. 

  • Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs. 

  • Strong client management skills 

  • Strong technical skills in the ever-changing electronic arena 

  • Strong strategic direction building and building those skills in management team 

  • Strong project management skills. 

  • Strong negotiation skills. 

  • Interpersonal skills that allow for harmonious relationships with providers, members and coworkers. 

  • Recognize strategic opportunities and use data to make timely and sound decisions. 

  • Knowledge of how to brainstorm process improvements and assist management with project selection criteria. 

  • Strong knowledge of the healthcare industry. 

  • Experience in conceptualizing new business architecture and infrastructure. 

  • Knowledge of statistical concepts and capabilities. 

  • Knowledge of principles and methods related to effectively implementing change management.  

  • Flexibility and willingness to adjust to shifting demands/priorities.  

Required Leadership Experience and Competencies 

  • High standard of performance while pursuing aggressive goals 

  • Principled leadership and sound business ethics 

 

PREFERRED COMPETENCIES 

Preferred Job Skills 

  • N/A 

Preferred Professional Competencies 

  • N/A      

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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