Blue Cross Blue Shield of Arizona

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 - REQUIRED 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. - PREFERRED QUALIFICATIONS - 3 years of experience in clinical field of practice, health insurance, or other health care related field - Bachelor's Degree in Nursing or related field of study - Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse Requirements - Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person. - Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Maintain complete and accurate records per department policy. - Meet 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. - 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. - Demonstrate ability to apply plan policies and procedures effectively. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - 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 developments in the fields of medicine and managed care. - Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements. - The position has an onsite expectation of 5 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. - Perform all other duties as assigned. 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. Our positions are classified as hybrid, onsite or remote. - 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.

Role Description Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation. Perform data extraction, healthcare cost analysis, analytical model development, as well as production of various reports to support corporate strategies and initiatives. Execute complex analyses that guide the development of reimbursement policy, provider negotiations, network development, value-based care, population health management, utilization management programs and other medical cost containment solutions. Qualifications - REQUIRED QUALIFICATIONS - Required Work Experience - 1 year of experience in data analysis using analytic tools and processes (Level 1) - 3 years of experience in data analysis using analytic tools and processes (Level 2) - 3 years of experience working for a healthcare organization/health insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 3) - 5 years of experience working for a healthcare organization/health insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 4) - Required Education - Bachelor's Degree in mathematics, statistics, business, or related field of study (Applies to All Levels) - PREFERRED QUALIFICATIONS - Preferred Work Experience - 1 year of experience in data analysis working for a healthcare organization / health insurer (Level 1) - 3 years of experience working for a healthcare organization / health insurer, including development of business analytics and financial impact analyses (Level 2) - 5 years of experience working for a healthcare organization / health insurer, including development of business analytics and financial impact analyses (Levels 3, 4) - Preferred Education - Master’s Degree in mathematics, statistics, business, or related field of study. (Applies to All Levels) Requirements - Level 1 - Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis in support of multiple strategic goals, mandates, and legislation - Develop processes, write programs and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions - Identify, analyze, interpret and validate healthcare data metrics, trends and patterns - Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies. - Model financial impact analyses for a variety of business initiatives - Partner with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards - Act as liaison to both internal business partners and external providers or vendors - Create, modify, maintain, and enhance existing programming or business processes associated with specific responsibilities. - Interpret, communicate, and present results to all levels of management in consistent and easy to understand formats to facilitate fact-based decision-making. - Complete projects within preset timelines and report status to supervisor and project manager. - Prepare written documentation on projects to provide a peer review trail and ensure continuity and integrity. - Build and maintain close working relationships with internal stakeholders and key external client contacts (e.g. Providers, Internal Clinicians, Vendors, Customers, Brokers, BCBS Association, Blues Plans, Auditors). - Level 2 - Serve as an internal analytics consultant to define business questions and transform data and analysis into meaningful and actionable information for a variety of business areas - Perform complex analyses and interpret complex calculations to recommend actions and solutions - Develop financial models needed to accomplish analytic goals - Serve as subject matter expert for internal stakeholders - Design and deliver self-service business intelligence tools to internal customers - Make sound assumptions and fact-based recommendations and discuss with supervisor, manager, or project manager. - Effectively communicate results and recommendations to internal and external customers. - Provide self- and peer-review of job responsibilities - Share knowledge of skills, projects, and business needs with peers and less-experienced analysts. Train new analysts. - Report to a supervisor or manager who provides general supervisory instructions, manages projects and reviews results. Develops own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager. - Level 3 - Create and research analyses and recommendations which help achieve corporate initiatives and goals - Produce complex analytic solutions and consolidate complex analytics into easy-to-understand presentations focused on business implications - Deliver business intelligence to clients by applying and demonstrating expertise in the areas of advanced analytics, forecasting, data extrapolation, and predictive modeling - Communicate (both verbally and in writing) and interpret results, recommendations and abstract concepts to internal and external customers. Anticipate and address possible customer questions and concerns. - Report to a supervisor or manager who provides minimal supervisory instructions, limited project management, and minimal or limited review of results beyond pre-release peer review. - Train and mentor other analysts. - Level 4 - Drive and implement complex and critical analytic initiatives with minimal oversight. Includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring post-implementation issues. - Represent the department when meeting/strategizing with leadership of other areas, practicing situational awareness and balancing the business needs with prioritization of analytics resources. - Review results post-implementation to ensure projections are realized and recommend modifications as applicable. - Incorporate strategic planning in all areas of responsibility, collaborating with internal business partners to define and execute strategy or direction. - Participate in leading overall strategic direction and execution of data, analytical and reporting capabilities, tools, outputs, insights and business/clinical interpretation and advisory services. - 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. Benefits - 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.

Role Description 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 - 2 year(s) 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 or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D - 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. - 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). Requirements - 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 - Bachelor's Degree in Nursing or Health and Human Services related field of study - 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. - 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. Required Competencies - Intermediate PC proficiency - Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones - Intermediate skill in word processing, spreadsheet, and database software - Maintain confidentiality and privacy - Advanced and current clinical knowledge - Practice interpersonal and active listening skills to achieve customer satisfaction - 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.

Role Description This position is responsible for maintaining and supporting the Medicare and/or Medicaid formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare and/or Medicaid health plan departments and personnel. This position has the latitude for independent decision-making within the limits of acceptable standards of pharmacy practice and state and federal laws. This position requires interactions at all levels of staff and management. External interactions include network physicians, and health plan members, etc. Qualifications - 5 years or more as a practicing pharmacist - 3 years of experience in the managed care pharmacy field - 2 years of direct prior authorization experience - 2 years of managed care/health plan and/or pharmacy benefits experience - Doctor of Pharmacy (Pharm.D) degree - Active, current and unrestricted State of Arizona pharmacist license - Medicare Part D experience highly desirable (preferred) - Pharm. D with residency or fellowship preferred (preferred) - Geriatric certification (preferred) Requirements - Proficient in critical literature evaluation skills, including evidence-based medicine principles - Excellent problem-solving 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 in word processing, spreadsheet and database software - Intermediate skill using departmental BCBSAZ and BCBSA software - Must have effective human relations and verbal/written communication skills - Must have an understanding of the interrelationships of health plan pharmacy components, members, and providers - Proficiency with PC based productivity tools required - Needs analytical ability to support decision making - Flexible skills in an operationally changing environment - Strong customer service 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 - Flexibility and willingness to adjust to shifting demands/priorities Benefits - Remote work opportunity requires residency within the State of Arizona - Hybrid workforce strategy offers flexibility with how and where employees work - Onsite requirements may change based on business need and job responsibilities 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 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 - Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person. - Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Maintain complete and accurate records per department policy. - Meet 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. - 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. - Demonstrate ability to apply plan policies and procedures effectively. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - 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 developments in the fields of medicine and managed care. - Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements. - Perform all other duties as assigned. Benefits - 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. Our positions are classified as hybrid, onsite or remote. - 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.

• Perform detailed payroll account reconciliations, including general ledger entries, variance analysis • 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

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.

• Facilitate the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers • Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations • Coordinate Credentialing Committee meetings • Identify and communicate agenda items for Credentialing Committee to immediate leader • Facilitate prompt coordination with the Credentialing Verification Organization (CVO) • Review and maintain all applications for accuracy and completeness • Accurately and efficiently data enter primary source verification data into the credentialing database • Generate and mail approval letters to participating providers • Communicate with Network Services regarding status of provider and organizational credentialing

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.