Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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.

PURPOSE OF THE JOB

* Responsible for processing complex paper and electronically submitted claims and correspondence that require further investigation; and coding, resolving pended claims and processing adjustments.

* Manage personal inventory, follow all applicable guidelines, meet service levels and objectives.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

* 2 years of experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field

2. Required Education

* High-School Diploma or GED in general field of study

3. Required Licenses

* N/A

4. Required Certifications

* N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

* 3 year of experience in claim processing, customer service, call center, health insurance, medical office, or other healthcare-related field

2. Preferred Education

* Associate's Degree in general field of study

3. Preferred Licenses

* A valid Arizona driver license with an acceptable driving record if travel is required (e.g. regional employees)

4. Preferred Certifications

* N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

* Identify, research, process, resolve and respond to written or electronically submitted correspondence.

* Research and process claims/system editing according to business regulation, internal standards and processing guidelines. Verify all pertinent information such as coding of procedure and diagnosis codes.

* Meet quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within department guidelines.

* Knowledge of coordination of benefit principles and terminology. * Manage email proxy boxes and escalation emails as assigned.

* Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.

* Document clear and concise records in regard to correspondence by updating BCBSAZ files and system.

* Maintain documentation and stay familiar with current procedural policies for appropriate computer system and coding guidelines.

* Provide claims and/or correspondence updates as requested.

* Support Customer Service management in meeting the corporate and department goals and objectives.

* Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.

* Travel may be required for employees in regional offices * Experience with multi-tasking and prioritizing

* 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.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

* Type 30 to 35 words per minute with 5% error rate or less

* Intermediate PC proficiency

* Strong oral and written communication skills

* Proficient spelling, punctuation and grammar skills

2. Required Professional Competencies

* Maintain confidentiality and privacy

* Compose and dictate a variety of business correspondence

* Interpret and translate policies, procedures, programs and guidelines

* Capable of investigative and analytical research

* Navigate, gather, input and maintain data records in multiple system applications * Follow and accept instruction and direction

* Establish and maintain working relationships in a collaborative team environment

3. Required Leadership Experience and Competencies

* N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

* Intermediate knowledge of CPT, HCPCS and ICD9 claim coding

* Intermediate understanding of dental and medical terminology

* Intermediate comprehension of anatomy and medical practices

* Advanced bilingual (Spanish/English) skill in verbal communication

* Intermediate bilingual (Spanish/English) skill in written communication

1. Preferred Professional Competencies

* Knowledge of a wide range of subjects pertaining to the organization's service and operations

2. Preferred Leadership Experience and Competencies

* N/A

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.