Blue Cross Blue Shield of Arizona

Initial Clinical Reviewer - Remote - AZ

Blue Cross Blue Shield of Arizona · Full Time · 6 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Initial Clinical Reviewer is responsible for identifying, researching, and resolving customer inquiries while applying medical necessity criteria to benefit requests. They must maintain accurate records and coordinate with internal and external stakeholders to ensure compliance with health insurance standards.

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Integrated Care Manager- Remote AZ

Blue Cross Blue Shield of Arizona · Full Time · 14 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 analyzing medical records, collaborating with providers, and handling a high volume of health insurance inquiries.

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Integrated Care Manager (Maternal Health) - Remote

Blue Cross Blue Shield of Arizona · Full Time · 16 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for promoting continuity of care through assessing, planning, and coordinating health care services for members. The role involves analyzing medical records, collaborating with providers, and handling high-volume customer inquiries regarding benefits and coverage.

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Finance Project Implementation Coordinator- Remote AZ

Blue Cross Blue Shield of Arizona · Full Time · 22 days ago

Blue Cross Blue Shield of Arizona

🌎 United States ⭐ 5-10 yrs exp 💼 Finance

Leads and coordinates corporate projects within the Finance division, focusing on billing, claims payments, and financial system initiatives. Acts as a liaison between IT, vendors, and business customers to develop system logic and business requirements.

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Finance Product Owner-Velocity Claim Payment Operations- Remote AZ

Blue Cross Blue Shield of Arizona · Full Time · 22 days 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 · a month 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 - Medicare Advantage (prior CM experience working in a health plan)- Remote

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 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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Medical Appeals and Grievance (MAG) Specialist II - Remote

Blue Cross Blue Shield of Arizona · Full Time · 2 months 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 · 2 months 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 · 2 months 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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