Blue Cross Blue Shield of Arizona

Role Description The detail-oriented and analytical Payroll Analyst with a strong accounting background will support and enhance our payroll operations. This role is responsible for: - Payroll reconciliations - Payroll accounting / journal entries - Process improvement - Compliance with federal and state regulations - Supporting system enhancements and testing in Workday - Payroll accuracy, reconciliation, and accounting integrity within Workday - Supporting analytics, automation, and emerging AI use cases Qualifications - 3 years of experience in multi-state payroll processing - 2 years of experience in analysis, auditing, and process improvement - 1 year of experience with accounting or financial analysis - High-School Diploma or GED Requirements - 5 years of experience in multi-state payroll processing (preferred) - 2 years of experience with payroll accounting and journal entries (preferred) - 2 years of experience with Workday payroll and timekeeping modules in a mid-to-large organization (preferred) - Associates or Bachelor’s Degree in accounting, business, or related field of study (preferred) - Certified Payroll Professional (preferred) Benefits - Flexible hybrid workforce strategy - Remote work opportunity within the state of Arizona Essential Job Functions and Responsibilities - Payroll Processing, Reconciliation & Accounting: - Perform detailed payroll account reconciliations, including general ledger entries, variance analysis, and timely resolution of discrepancies - Prepare, review, and post payroll-related journal entries in accordance with accounting standards - Partner with Accounting/Finance teams to ensure payroll activity is accurately reflected in the general ledger - Support month-end, quarter-end, and year-end close processes related to payroll - Maintain audit-ready payroll records and ensure compliance with internal controls and audit requirements - Assist with internal sales processes, data, and calculations - HRIS (Workday) Support & Testing: - Lead testing for Workday payroll and HRIS releases, including regression testing and user acceptance testing (UAT) - Document system design and processes for training, reference, and education of payroll staff and employees on processes and system functionality - Create, track, and resolve Workday tickets related to payroll issues, enhancements, and system defects - Collaborate with HRIS and IT teams to ensure system functionality aligns with payroll requirements - Process Analysis & Improvement: - Analyze current payroll processes, identify inefficiencies, and recommend improvements and innovative solutions while ensuring adherence to internal controls - Evaluate and apply AI‑enabled tools (e.g., Copilot, workflow automation, analytics assistants) to improve payroll reconciliation, audit support, reporting, and operational efficiency - Develop, document, and maintain standard operating procedures and internal controls - Support implementation of process improvements, automation initiatives, and system enhancements - Maintain data integrity processes that need improvement and recommend improvements - Setup and maintain Standard Operation Procedures (SOPs); including working with internal and external auditors on process workflows and key audit controls - Compliance & Legislative Analysis: - Monitor and interpret federal, state, and local payroll legislation, including wage and hour laws and tax updates - Evaluate the impact of regulatory changes on payroll processes and systems - Recommend and support implementation of changes to ensure ongoing compliance - Partner with HR, Legal, and Finance teams to maintain compliant payroll practices - Reporting & Data Analysis: - Generate, analyze, and interpret payroll reports to ensure accuracy and identify trends or anomalies - Maintain/implement custom reports in Workday or other reporting tools to support business needs; audit requests such as 401k, worker’s comp, and internal/external audit requests - Provide data-driven insights and recommendations to leadership 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.

Role Description Serves as the primary technical and analytical resource responsible for understanding how member, policy, premium, and agent assignment data flows from source systems into SAP Agent Performance Management (Callidus/APM), and how that data is used organizationally across commission processing, broker portal display, book of business management, and enterprise reporting. Qualifications - 3 years of experience in information systems analysis, data analysis, or a technical business analyst role in a complex business environment - 2 years of experience writing business or systems requirements documentation, including user stories, functional specifications, or source-to-target mapping - 2 years of experience conducting data audits, root cause analyses, or data reconciliations in a production environment - 2 years of experience working with ETL processes, delta file generation, or staged data delivery workflows - 1 year of experience applying automation tools, scripting, or AI-assisted technologies to improve data processing, reporting, or analytical workflows - High-School Diploma or GED in general field of study (All Levels) Requirements - Maintains expert working knowledge of how member, policy, premium, and agent assignment data originates in source systems and flows through staging, transformation, and delivery into SAP APM (Callidus) for broker commission processing - Understands how systems route broker-relevant data from upstream sources to Callidus, including the rules governing delta file generation, record comparison logic, and data validation - Works closely with the Callidus product owner to understand how Callidus data is consumed organizationally beyond commissions - Writes and maintains intermediate to advanced SQL queries various data sources, relevant stages, and related databases to support commission file generation, reconciliation, reporting, and audit activities - Applies AI-assisted query and data analysis tools to accelerate investigation of large datasets, identify patterns in commission anomalies, and surface data quality issues - Serves as the Broker Commissions data SME for the broker portal, providing data clarification, analysis, and requirements support - Investigates and resolves broker portal data discrepancies including commission display errors, book of business inaccuracies, agent/firm association issues - Leads or participates in requirements-gathering sessions with business stakeholders, IT partners, Data Governance, Digital Product, and vendor teams - Writes clear and structured business requirements, functional specifications, user stories, and source-to-target mapping documents - Develops and maintains documentation including processing narratives, desk-level procedures, data dictionaries, business rule libraries, and audit reference materials - Writes and maintains SQL scripts, Alteryx workflows, and other code used to generate and validate commission input files - Identifies, designs, and implements automation solutions to reduce manual intervention, improve processing speed, and increase reliability in commission data delivery pipelines - Tests and validates system changes, configuration updates, data loads, and file format changes prior to deployment or UAT handoff - Contributes to and supports enterprise and departmental project work related to broker commissions data Benefits - Full-time work schedule defined as working at least 40 hours per week, plus any additional hours as requested or needed to meet business requirements. Company 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.

Role Description The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards. Qualifications - 2 years of experience in a healthcare field - 2 years of experience in provider credentialing - High-School Diploma or GED in general field of study - Associate's Degree in general field of study (preferred) - Certified Provider Credentialing Specialist (CPCS) (preferred) Requirements - Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations - Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes - Identify and communicate agenda items for Credentialing Committee to immediate leader - Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file - Promptly address incoming files for processing - Review and maintain all applications for accuracy and completeness - Accurately and efficiently data enter primary source verification data into the credentialing database - Input credentialing decisions and dates into the credentialing database - Generate and mail approval letters to participating providers - Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain - Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process - Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing - Maintain ongoing participation in cross-training activities - Provide recommendations and feedback regarding process improvements and/or standardization practices - Actively participate in staff meetings, team huddles, and one-on-one meetings - Engage in team building activities - Perform all other duties as assigned Benefits - This position is remote within the state of AZ only. - The position has an onsite expectation of 0 days per week and 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. Company 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. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.

Role Description Responsible for supporting members in achieving self-efficacy in managing their health condition(s) through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates self-management strategies and care services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes. Qualifications - 2 years of experience in full-time equivalent of direct clinical care to the consumer - Associate’s Degree in general field of study or Post High School Nursing Diploma - Active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, or active registration as a Registered Dietician (RD) or Registered Dietitian Nutritionist (RDN), or active registration as a Respiratory Therapist/Respiratory Care Practitioner. Requirements - 3 years of experience in full-time equivalent of direct clinical care to the consumer - 1-2 years of experience working in a managed care organization - Experience working with individuals living with chronic conditions such as: Diabetes, CHF, COPD, CAD, CKD, and asthma - Bachelor's Degree in Nursing or Health and Human Services-related field of study - Diabetes Care and Education Specialist (DCES) (formerly Certified Diabetes Educator (CDE)) - Certified Lifestyle Medicine Professional - Certified Health Coach - Case Management Certification Benefits - Flexible work arrangements under the Workability strategy - Remote work opportunity within the state of Arizona Essential Job Functions and Responsibilities - Perform assessments, condition management education, training, and other clinically based activities to coordinate care among providers, members, and family to implement the care plan. - Conduct member-centered planning, including shared goal setting and member-tailored education and interventions to support the member in achieving self-efficacy for condition management. - Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs. - Recommend and refer services and resources to members based on their individualized needs, specific health plan, and community and cultural preferences. - Make and answer a diverse and high volume of condition management-related member calls on a daily basis. - Explain to members a variety of information concerning the organization’s services, including but not limited to contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc. - Analyze medical records, claims data, and other information sources. - Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director. - Consult and coordinate with other Health Managers, various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of member inquiries. - Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines. - Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other applicable accreditation requirements. - Maintain complete and accurate records per department policy. - Demonstrate ability to apply plan policies and procedures effectively. - Collaborate with team to distribute workload/work tasks. - Monitor and report team tasks. - Communicate team issues and opportunities for improvement to supervisor/manager. - Support/mentor team members. - Participate in continuing education and current development in the field of medicine, disease self-management, social drivers of health, behavioral health and managed care. - Represent BCBSAZ and the Health Management Program at member events up to 5% of the time. - Volunteer within the community to help BCBSAZ give back. - Perform all other duties as assigned. Required Competencies - Intermediate PC proficiency - Intermediate skill in the use of office equipment, including copiers, fax machines, scanners and telephones - Intermediate skill in word processing, spreadsheet, and database software - Maintain confidentiality and privacy - Advanced and current clinical knowledge, particularly as it relates to common chronic conditions including asthma, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disorder, congestive heart failure, and diabetes - Practice interpersonal and active listening skills to achieve customer satisfaction - Knowledge of health and/or patient education and behavior change techniques - Interpret and translate policies, procedures, programs, and guidelines - Capable of investigative and analytical research - Demonstrated organizational skills with the ability to prioritize tasks and work with multiple priorities - Follow and accept instruction and direction - Establish and maintain working relationships in a collaborative team environment - Apply independent and sound judgment with good problem solving skills - Navigate, gather, input, and maintain data records in multiple system applications 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.

• Perform medical technology research to support the Medical Director Staff and Medical Policy Panel with decisions to ensure that medical policies are consistent with the standards of accepted medical practice in the community. • Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel. • Communicate medical policy information in protocol format to all areas of BCBSAZ requiring this information. • Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion. • Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies.

• Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members • Interview and collaborate with case-related providers, member and family to implement the care plan • Answer a diverse and high volume of health insurance related customer calls on a daily basis • Present status reports on all cases to the manager/supervisor and to the medical director when indicated • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines

Role Description Responsible for quality functions for the health services business unit, which includes processing complaints and providing professional oversight on vendor delegation and quality management activities. Provide clinical and operational analysis and project coordination support/leadership to the Health Services business unit. Qualifications - 2 years of experience in a clinical field of practice, health insurance, or other health care related field - Associate's Degree in general field of study, or post high school nursing diploma - Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse Requirements - 2+ years of experience in health insurance field - 2+ years of experience processing potential quality inquiries - 2 years of Medicare experience - Bachelor's Degree in Nursing or related field of study Essential Job Functions and Responsibilities - Receive and document complaints regarding potential quality of care concerns. - Conduct clinical review of complaints received for quality of care concerns. - Document and present cases to Medical Director for clinical review and decision. - Track results of cases presented and outcomes of the clinical reviews. - Review medical records as needed for quality of care and other corporate initiatives. - Meet quality and timeliness standards to achieve individual and departmental performance goals. - Consult and coordinate with various internal departments, external plans, providers, vendors, businesses, and government agencies. - Document and record facts regarding inquiries, correspondences, and projects. - Demonstrate and maintain current working knowledge of required BCBSAZ systems, procedures, forms, and manuals. - Comply with all state and federal regulations for activities performed. - Support oversight of program data collection and create reports to evaluate current programs. - Create and maintain job aids and documentation of processes to maintain URAC accreditation. - Collaborate with team to distribute workload/work tasks. - Monitor and report team tasks. - Communicate team issues and opportunities for improvement to supervisor/manager. - Support/mentor team members. - Perform all other duties as assigned. Required Competencies - Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones. - Intermediate PC proficiency including word processing, spreadsheet, and database software. - Health care payer business knowledge including processes and operational data. - Maintain confidentiality and privacy. - Capable of investigative and analytical research to make decisions and recommendations. - Independent and sound judgment with good problem-solving skills. - Knowledge of managed care, utilization management, and quality management. - Establish and maintain working relationships with health care providers, members, and coworkers. - Strong verbal and written communication skills. - Practice interpersonal and active listening skills to achieve customer satisfaction. - Ability to interpret policies, programs, and guidelines. - Organizational skills with the ability to prioritize tasks and work with multiple priorities. 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.

Role Description Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry. Qualifications - 2 years of experience in clinical field of practice, health insurance, or other health care related field - Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program - Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN. Requirements - 3 years of experience in clinical field of practice, health insurance, or other health care related field (Preferred) - Bachelor's Degree in Nursing or related field of study (Preferred) - Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (Preferred) Benefits - Full-time work schedule defined as working at least 40 hours per week, plus any additional hours as requested or needed to meet business requirements Company 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. - Hybrid workforce strategy called Workability, offering flexibility with how and where employees work. - Onsite requirements may change in the future based on business need and job responsibilities. - This remote work opportunity requires residency and work to be performed within the State of Arizona.

Role Description Responsible for supporting the UM/Care Management Department by providing professional oversight with an emphasis on regulatory requirements and those processes related to State, Federal, BCBSAZ, Accreditation and Medicare. This position will also lead and coordinate or participate in the processes of initial delegation and ongoing oversight of delegated entities. The position will coordinate or participate in the Delegation Committee to assure multi-department compliance and coordination. Additionally, this position will assist in various aspects of accreditation, delegation, and CMS activities. Qualifications - Required Work Experience - Level 1: 1 year of experience in clinical and health insurance or other healthcare related field - Level 2: - 2 years of experience in clinical and health insurance or other healthcare related field - 1 year of managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements - Level 3: - 3 years of experience in clinical and health insurance or other healthcare related field - 2 years of managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements - 5 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements. - Required Education - Associate degree in Nursing or Post High School Nursing Diploma - Required Licenses - Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse Requirements - Preferred Work Experience - 3 years of experience in clinical field of practice, health insurance, or other health care related field - 2 years of experience working on healthcare-related systems - 2 years of experience in delegation, accreditation, or regulatory environment - 1 year of experience leading improvement projects - 1 year of experience in data analysis - 1 year of experience in accreditation or Medicare Quality Regulations - Preferred Education - Bachelor's Degree in Nursing - Master’s in Nursing, Public Health or other related field - Preferred Certifications - Certified Case Manager (CCM) - Certified Professional in Healthcare Management (CPHQ) - Certified Professional in Healthcare Quality - Certified Managed Care Nursing Benefits - Develop and document health improvement/management programs for members in compliance with applicable state, federal, accreditation and Medicare regulations. - Support business processes and data flows and how they affect health management/BCBS processes, systems and other operational areas. - Participate in and/or lead process improvement, quality for accreditation or Medicare improvement projects. - Analyze and/or oversight of program data collection and reports to evaluate current programs. - Research and analyze procedural problems and provide recommendations for improvements and changes. - Consult and coordinate with various internal departments, external plans, providers, vendors, businesses and government agencies to obtain information to meet departmental projects and goals. - Create and maintain the following as applicable: - Policies for the UM/Care Management Departments - Documentation of processes to maintain URAC accreditation and Medicare regulations - Responsible for the running or participating in the Delegation Committee. Activities may include scheduling, documentation and retention of all materials per the BCBSAZ guidelines. - Provide and/or monitor and audit all evidence provided by the vendors to ensure complete and gaps are closed. - Create and/or update correspondence as required per the position. - Development and delivery of training materials to stakeholders in Accreditation and Regulatory processes. - Monitor delegated entities for quality and contract requirements and maintain reporting for evaluation and departmental reporting. - Document and record facts in regard to inquiries, correspondences and projects by updating files and systems. - Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals. - Maintain all standards in consideration of State, Federal, FEP, Medicare, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions. - The position requires a full-time work schedule. Full-time is 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. Company Description 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.

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. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: - Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week - Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week - Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month - Onsite: daily onsite requirement based on the essential functions of the job - Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. Purpose of the job Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes. This job description is primary for case management functions but can assist with utilization management if a business need arises. Qualifications REQUIRED QUALIFICATIONS Required Work Experience - 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer Required Education - Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D Required Licenses - Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN. Required Certifications - Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC). PREFERRED QUALIFICATIONS Preferred Work Experience - 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred) - 1-2 year (s) of experience working in a managed care organization Preferred Education - Bachelor's Degree in Nursing or Health and Human Services related field of study Preferred Licenses - N/A Preferred Certifications - Active and current certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC). ESSENTIAL job functions AND RESPONSIBILITIES - Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan. - Answer a diverse and high volume of health insurance related customer calls on a daily basis. - Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines. - Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements. - Maintain complete and accurate records per department policy. - Demonstrate ability to apply plan policies and procedures effectively. - When indicated to assist with team/project functions: - Collaborate with team to distribute workload/work tasks; - Monitor and report team tasks; - Communicate team issues and opportunities for improvement to supervisor/manager; - Support/mentor team members. - Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually. - 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. 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.