Jobs at Blue Cross Blue Shield of Arizona

Owns and prioritizes the product backlog for real-time EDI 27X capabilities. Creates and decomposes business requirements into user stories, defines acceptance criteria, supports Scrum ceremonies, reviews test cases, accepts completed stories, and represents business needs to technology teams. The role also coordinates projects, forecasts effort, supports governance and quality programs, mentors team members, manages stakeholder communication, and develops processes for advancing technology capabilities.

Reviews health insurance inquiries and correspondence, analyzes medical records, applies medical necessity criteria and benefit plan requirements, resolves customer issues, and explains coverage, eligibility, claims, programs, and provider networks. Maintains accurate records, meets quality and timeliness standards, coordinates with internal and external stakeholders, supports team workload distribution, and maintains compliance with regulatory and accreditation requirements.

Designs, develops, integrates, tests, and validates complex healthcare software. Provides architecture and coding expertise, leads technical proposals and program objectives, defines features, supports customers, and serves as the primary technical authority. Requires hands-on QNXT experience, healthcare software architecture expertise, integration experience, analytics knowledge, software development lifecycle understanding, and configuration and change management knowledge.

Supports healthcare EDI and flat-file processes by analyzing systems and data, troubleshooting production issues, writing SQL queries, developing mappings and technical documentation, testing files and applications, monitoring integrations, and providing user support. The role also contributes to root-cause analysis, defect management, regulatory transaction research, project planning, and production monitoring. Senior-level employees mentor peers and lead complex technical projects.

Manages ACA program integrity, regulatory compliance, vendor performance, financial oversight, audit responses, QHP and Open Enrollment readiness, and process improvement. Coordinates vendors and cross-functional stakeholders, monitors contracts and service levels, validates invoices and budgets, develops performance reporting, investigates risks, and supports corrective actions and regulatory deliverables.

Owns and prioritizes the product backlog for real-time EDI 27X capabilities. Develops business user stories and acceptance criteria, partners with Scrum Masters and project managers, supports Agile ceremonies, reviews test cases, accepts completed stories, and aligns product priorities with customer and business needs. The role also evaluates project effort, supports planning, mentors team members, develops procedures, and coordinates with business, IT, operational, and third-party stakeholders.

Negotiates and manages healthcare provider contracts for Arizona Medicaid and D-SNP networks. Responsibilities include recruiting providers, leading negotiations and value-based payment agreements, developing network strategies, analyzing contract financial structures, recommending contract language changes, ensuring regulatory compliance, overseeing contract setup for claims processing, and coordinating with internal departments, health plans, providers, business partners, and government agencies. The role also mentors entry-level staff and requires strong analytical, negotiation, leadership, and collaboration skills.

Supervise utilization review team for Medicaid members, ensuring timely, medically appropriate inpatient/observation/sub-acute authorizations using InterQual; monitor performance metrics, conduct audits, prepare reports, train and manage staff, support regulatory audits and quality improvement. Hybrid role requiring Arizona residency and onsite presence two days weekly.

Design and deliver enterprise data integration and application architectures. Lead technical design from concept through production, guide engineering teams, ensure scalable, secure, maintainable solutions, produce architecture artifacts, and mentor staff while aligning implementations with business needs.

Provide in-house legal services including negotiating and drafting contracts, advising on healthcare, IT (AI and cybersecurity), procurement, and regulatory compliance; manage vendor and related-party agreements; coordinate responses to complaints and investigations; support No Surprises Act compliance; work with Internal Audit on fraud matters; engage internal clients to deliver legal advice aligned with business objectives.

Lead BI analyst responsible for developing and maintaining data warehouse reports, mapping source systems to BI systems, building ETL/OLAP solutions, ensuring data quality and metadata management, mentoring staff, supporting production cycles, and providing user training and support in a hybrid Arizona-based role.

Serve as Product Owner for claims payment operations, working with business, vendors, and IT to define and prioritize backlog, create user stories, ensure traceability, accept completed stories, support UAT, and mentor team members. Drive product backlog grooming, sprint participation, and stakeholder communication to deliver payment and claims features.

Provide direct primary care to clinic patients, evaluate and treat per standards, document timely, coordinate referrals and services, participate in team-based huddles and population health activities, support quality improvement, comply with licensing and policy, and work onsite at Arizona care centers (may move between clinics and include extended hours).

Manage Edifecs EDI platform health, governance, vendor relationships, and TPDM operational excellence across EDI, ETL, and Delivery pillars. Own intake & triage, metrics/scorecards, documentation governance, capacity/technical-debt management, and cross-pillar escalations. Coach and develop staff, drive continuous improvement, manage SLAs and vendor performance, and translate strategic initiatives into executable plans.

The physician will provide direct patient care, ensuring excellence in service and compliance. Responsibilities include patient evaluation, documentation, care coordination, and collaboration with healthcare teams.

Lead enterprise architecture strategy and roadmaps, model data/application/technical architectures, govern application portfolio management, consult with business and IT teams, support PMO and project lifecycles, research/validate technologies, and mentor teams to ensure secure, scalable, interoperable solutions aligned with business goals.