Blue Cross Blue Shield of Arizona
Phoenix, Arizona, United States
BPO Oversight Specialist III
Job 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.
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 (UAT), and act as a liaison between business customers, external customers, project teams and IT.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
1. Required Work Experience
2 years of experience in a role with demonstrated ability to communicate with diverse groups of people inside and
outside of the business (Levels 2 - 4)
2 years of experience triaging issues from start to finish for members and/or providers. (Levels 2 - 4)
3 years of experience in healthcare or operations (All Levels)
3 years of experience in healthcare production field or quality auditing field (All Levels)
3 years of experience in developing and implementing process improvement initiatives (Levels 2 - 4)
2. Required Education
High-School Diploma or GED in general field of study (All Levels)
3. Required Licenses
N/A
4. Required Certifications
N/A
PREFERRED QUALIFICATIONS
1. Preferred Work Experience
1 year of experience in project management (Levels 2 - 4)
1 year of management experience (Levels 2 - 4)
3 years of experience triaging issues from start to finish for members and/or providers. (Levels 2 - 4)
5 years of experience in a role with demonstrated ability to communicate with diverse groups of people inside and
outside of the business (Levels 2 - 4)
5 years of experience in healthcare or operations (All Levels)
5 years of experience in healthcare production field or quality auditing field (All Levels)
5 years of experience in healthcare or insurance field with an emphasis on Business Analysis (Levels 2 - 4)
2. Preferred Education
Bachelors Degree in Computer Science, Information Systems, Business, or related field (All levels)
3. Preferred Licenses
N/A
4. Preferred Certifications
N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
LEVEL 1
Write and review business requirements, flow specifications or change requests
Write test scripts, perform testing and post-production validation
Conduct research and analysis for issue resolution relating to electronic transactions, customer service applications, claim adjudication systems including reporting, process efficiencies. Track all items through to resolution.
Provide first or second level support for internal/external customers
Utilize problem-solving skills to improve procedures and processes, resolve system deficiencies and implement enhancements
Act as a liaison between external/internal customers and IT; communicate system and process changes to business areas
LEVEL 2
Develop moderate complex (e.g. multiple departments/systems) business requirements on large projects and flow specifications with limited management direction.
Provide support to external customers to onboard Healthcare EDI processing and achieve HIPAA Transaction and Code Set compliance.
Provide subject matter expert (SME) advice related to electronic transactions and other corporate systems in the prioritization of workload or issue research. Facilitate and/or create new operational procedures and processes resulting from advancing technologies or capabilities.
Lead small to medium size projects; act as UAT Coordinator including test strategy and plan development
Interpret design specifications for comparison against defined business needs to ensure compatibility, consistency and completeness
Resolve differences between customers and other team members in order to achieve organizational and project goals
Utilize existing reporting tools to develop and execute data queries for ad hoc requests; understand data source structures
Understand EDI formats/syntax and file transfer protocols Support multiple segments of business
Mentors Level 1 Analysts
LEVEL 3
Develop complex (e.g. multiple departments/systems) business requirements on large projects and flow specifications with little to no management direction. Decompose high-level project information and evaluates project components to forecast work effort required
Act as lead business analyst for large or complex projects
Interpret business and technical design specifications and resolve conflicts that arise when compared against the defined needs of the business.
Fully support all business segments
Mentors Level 1 and 2 Analysts
LEVEL 4
Ensures Service Level Agreements between department and operational or technical areas are met Act as lead business analyst for large or complex projects with minimal guidance from lead or manager
Mentors all level of analysts
Proactively seeks opportunities to improve processes and procedures in support of customer satisfaction and corporate goals
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. Participate in on-call rotation
Perform all other duties as assigned
COMPETENCIES
REQUIRED COMPETENCIES
1. Required Job Skills (Applies to All Levels)
Strong analytical skills to support independent and effective decisions based on customer input and research
Strong problem-solving skills
Strong time management skills
Basic skills with core MS products: Word, Excel, IE, Outlook, Visio, PowerPoint
Basic skills with query tools
Strong understanding of file handling and data translation
Excellent verbal and written communication skills and the ability to interact professionally and maintain positive
working relationships with a diverse group
2. Required Professional Competencies (Applies to All Levels)
Prioritize tasks and work multiple priorities, sometimes under strict time constraints
Ability to build synergy with a diverse team in an ever-changing environment
Ability to exercise independent judgment and demonstrate creative problem solving techniques
Anticipates downstream impacts and factors in those considerations appropriately Perseverance in the face of resistance or setbacks
3. Required Leadership Experience and Competencies
Support priorities and direction of corporate leadership
Ability to apply sound management decision making skills to perform effectively in the absence of management
Effectively deal with conflict
Ability to present concepts effectively to varying levels of staff (Applies to Levels 2 - 4)
PREFERRED COMPETENCIES
1. Preferred Job Skills (Applies to All Levels)
Demonstrates an advanced knowledge of and experience with the development of business requirements, user
acceptance testing and their supporting toolsets.
Familiar with HIPAA compliance validation tools such as EDISM, Specbuilder or ClarEDI.
Familiar with claims and customer service processes
Experience with web portal business user support and change management activities
Formal business analyst training
2. Preferred Professional Competencies (Applies to All Levels)
Driven to identify solutions to meet customer needs.
Ability to work with ambiguous and conflicting information while keeping focused on the end goal.
Performs public speaking presentations within the industry
3. Preferred Leadership Experience and Competencies
N/A
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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.