BPO Oversight Specialist III - Phoenix, United States - Blue Cross Blue Shield of Arizona

Description

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

· Bachelor's 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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