BPO Oversight Specialist III - Hybrid

About this role

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 position is hybrid within the state of AZ only.  This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB On behalf of internal and external customers, gather and document business requirements, provide research and analysis related to project deliverables or production break/fix issues, conduct user acceptance testing, and act as a liaison among business customers, external customers, project teams, and Information Technology.

REQUIRED QUALIFICATIONS Required Work Experience All Levels: • 3 years of experience in healthcare or operations • 3 years of experience in a healthcare production or quality auditing environment

Levels 2-4: • 2 years of experience in a role demonstrating the ability to communicate with diverse groups inside and outside the business • 2 years of experience triaging member and/or provider issues from initiation through resolution • 3 years of experience developing and implementing process improvement initiatives

Required Education All Levels: • High school diploma or GED in a general field of study

Required Licenses • None

Required Certifications • None

PREFERRED QUALIFICATIONS Preferred Work Experience All Levels: • 5 years of experience in healthcare or operations • 5 years of experience in a healthcare production or quality auditing environment

Levels 2-4: • 1 year of project management experience • 1 year of management experience • 3 years of experience triaging member and/or provider issues from initiation through resolution • 5 years of experience in a role demonstrating the ability to communicate with diverse groups inside and outside the business • 5 years of experience in healthcare or insurance, with an emphasis on business analysis

Preferred Education All Levels: • Bachelor’s degree in Computer Science, Information Systems, Business, or a related field

Preferred Licenses • None

Preferred Certifications • None

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES LEVEL 1 • Write and review business requirements, process flows, specifications, and change requests • Write test scripts, perform testing, and conduct post-production validation • Conduct research and analysis to resolve issues involving electronic transactions, customer service applications, claims adjudication systems, reporting, and process efficiency • Track assigned issues through resolution • Provide first- or second-level support to internal and external customers • Apply problem-solving skills to improve procedures and processes, resolve system deficiencies, and implement enhancements • Serve as a liaison among internal customers, external customers, and Information Technology • Communicate system and process changes to affected business areas

LEVEL 2 In addition to the responsibilities of Level 1: • Develop moderately complex business requirements and process-flow specifications for large projects involving multiple departments or systems, with limited management direction • Support external customers with onboarding for healthcare electronic data interchange processing and HIPAA Transaction and Code Set compliance • Provide subject matter expertise related to electronic transactions and other corporate systems when prioritizing work or researching issues • Facilitate and/or create new operational procedures and processes resulting from advancing technologies or capabilities • Lead small- to medium-sized projects • Serve as a user acceptance testing coordinator, including developing test strategies and plans • Interpret design specifications and compare them with defined business needs to ensure compatibility, consistency, and completeness • Resolve differences among customers and team members to support organizational and project goals • Use existing reporting tools to develop and execute data queries for ad hoc requests • Understand data-source structures • Understand electronic data interchange formats, syntax, and file-transfer protocols • Support multiple business segments • Mentor Level 1 analysts

LEVEL 3 In addition to the responsibilities of Levels 1 and 2: • Develop complex business requirements and process-flow specifications for large projects involving multiple departments or systems, with little or no management direction • Decompose high-level project information and evaluate project components to f

Similar jobs

• Provider Contract Specialist III - Hybrid — BCBSAZ · AZ Blue Phoenix, AZ
• Head of P&S and Options BPO Operations (Hybrid) — Broadridge · Newark, NJ | Edgewood, NY
• Claims Specialist Supervisor (Hybrid) — First Am · Berwyn, Pennsylvania, United States
• Principal Specialist, Compensation Operations (Hybrid) — RTX · US-CT-FARMINGTON-0004 ~ 4 Farm Springs Rd ~ 4 FARM SPRINGS | US-IA-CEDAR RAPIDS-193 ~ 1120 Collins Rd NE ~ BLDG193
• Operational Support Senior Manager- Hybrid — The Cigna Group · Chicago, IL
• Senior Business Analyst (hybrid) — Johnson Controls · Cranston-Rhode Island-United States of America
• Senior Production Underwriting Specialist (Hybrid) — Amfam · WI Madison | MO St Joseph | MA Boston
• Operations Associate (Hybrid) — Broadridge · Newark, NJ