Jobs at Arkansas Blue Cross and Blue Shield

Provide nursing case management by assessing, planning, coordinating, implementing, monitoring, and evaluating care plans to optimize patient outcomes and cost-effective resource use. Serve as liaison among patients, families, clinicians, and community providers, maintain caseloads, ensure compliance with URAC and state regulations, and deliver disease-specific education and support.

Resolve medical claims that did not auto-adjudicate by investigating, entering data, reviewing benefits and codes, consulting providers/staff, routing or generating correspondence, and maintaining quality and productivity standards.

Retrieve, integrate, analyze, and validate business, medical, operations, financial and customer data. Build repositories, perform data extraction and manipulation, identify trends and root causes, produce reports and visualizations, support ad-hoc requests, and consult with stakeholders to inform business decisions and process improvements.

Support implementation, configuration, and optimization of Epic Payer Platform to enable bidirectional clinical and administrative data exchange with provider partners. Configure applications, onboard and test integrations, monitor data quality and mapping, troubleshoot issues, develop documentation and training, and support workflows such as prior authorization, claims, risk adjustment, and HEDIS reporting to improve operations and member outcomes.

Perform risk-based internal audits across operations, financial and non-financial reporting, and IT. Plan audits, conduct fieldwork, test controls, draft reports, support external audits and investigations, and advise on internal control improvements to enhance governance and compliance.