Blue Cross Blue Shield of Arizona

Finance Product Owner-Velocity Claim Payment Operations- Remote AZ

Blue Cross Blue Shield of Arizona · Full Time · 4 hours ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Product

Develop strategic plans for technologies impacting claim payment operations and manage the product backlog and prioritization of user stories. Act as the voice of the business to the IT team, ensuring traceability between requirements and final delivery.

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Medical Director (Medicaid Segment) - Remote-AZ

Blue Cross Blue Shield of Arizona · Full Time · 7 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Direct and provide professional oversight for medical management activities including utilization, case, disease, and quality management. Collaborate with physicians and hospitals to ensure medical policies align with community standards of good medical practice.

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Integrated Care Manager- Adult - Remote-AZ

Blue Cross Blue Shield of Arizona · Full Time · 7 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for promoting continuity of care by assessing, planning, and coordinating healthcare services for members to ensure quality and cost-effective outcomes. The role involves managing high-volume customer calls and collaborating with providers and families to implement care plans.

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Registered Nurse-Initial Clinical Reviewer (prior UM Health Plan experience)- Remote

Blue Cross Blue Shield of Arizona · Full Time · 13 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for researching and resolving customer inquiries regarding health insurance benefits and medical necessity. The role involves analyzing medical records to determine the appropriateness of benefit requests while maintaining compliance with state and federal standards.

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BH UM Clinical Reviewer- Remote AZ

Blue Cross Blue Shield of Arizona · Full Time · 13 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for processing and resolving customer inquiries while applying medical necessity criteria to benefit requests. The role involves analyzing medical records and coordinating with internal and external stakeholders to ensure compliance and excellence in health insurance services.

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Credentialing Coordinator - (Remote in Arizona)

Blue Cross Blue Shield of Arizona · Full Time · 14 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Facilitate the accurate credentialing and recredentialing of Medicaid providers in alignment with State, Federal, and NCQA standards. Coordinate Credentialing Committee meetings and manage primary source verification data within the credentialing database.

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Integrated Care Manager - Medicare Advantage (prior CM experience working in a health plan)- Remote

Blue Cross Blue Shield of Arizona · Full Time · 15 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for promoting continuity of care by assessing, planning, and coordinating care options for members to ensure quality and cost-effective outcomes. The role involves collaborating with providers and families while managing a high volume of health insurance inquiries.

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Analyst- Analytics and Data Science II-III (Remote)

Blue Cross Blue Shield of Arizona · Full Time · 19 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Provide strategic analysis and data extraction to impact business decisions, improve efficiency, and drive innovation within healthcare cost containment. Develop analytical models and reports to guide reimbursement policy, provider negotiations, and population health management.

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Medical Appeals and Grievance (MAG) Specialist II - Remote

Blue Cross Blue Shield of Arizona · Full Time · 25 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The specialist is responsible for managing medical appeals and grievances to ensure member satisfaction and regulatory compliance. This involves reviewing cases and coordinating with internal teams to resolve healthcare insurance disputes.

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High-Cost Claimant Review Unit Nurse Auditor

Blue Cross Blue Shield of Arizona · Full Time · a month ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 5-10 yrs exp 💼 Finance

Responsible for assessing member utilization and predicting future spend to improve member outcomes and optimize resource use. Collaborates with multi-disciplinary teams to identify community resources and lead process improvement initiatives for high-cost claimants.

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Business Intelligence Developer-Medicaid - Level I (Remote AZ)

Blue Cross Blue Shield of Arizona · Full Time · a month ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Design, create, and maintain sustainable reporting solutions and analytical insights to drive data-driven decision making for the Medicaid segment. Partner with business leaders to provide high-quality reporting on financial and clinical outcomes, network performance, and claims processing.

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Initial Clinical Reviewer - Remote - AZ

Blue Cross Blue Shield of Arizona · Full Time · a month ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for researching and resolving customer inquiries regarding health insurance benefits and medical necessity. The role involves analyzing medical records and coordinating with internal and external providers to ensure compliance and accuracy.

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Prior Authorization Nurse - Remote - AZ

Blue Cross Blue Shield of Arizona · Full Time · 3 months ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The nurse ensures the accuracy and timeliness of prior authorization requests by utilizing evidence-based standards for Medicaid and Medicare members. They also manage the Notice of Action process and coordinate care across departments to ensure quality outcomes.

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Medical Appeals and Grievance (MAG) Specialist II - Remote

Blue Cross Blue Shield of Arizona · Full Time · 3 months ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The specialist is responsible for researching, resolving, and responding to member and provider appeals, grievances, and corrected claims. They must maintain clinical accuracy and adhere to regulatory timelines while coordinating with internal and external stakeholders.

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