Jobs at Blue Cross Blue Shield of Arizona

Conduct primary and secondary market research to produce competitive intelligence for executive and business stakeholders. Collect, analyze, synthesize data into actionable reports, maintain competitor profiles and knowledge libraries, manage vendors/budgets, and deliver insights that inform strategic decisions using creative reporting formats.

Manage assigned product categories end-to-end: spend analytics, supplier performance, RFx and contract negotiations, category strategy, market benchmarking, pricing/cost models, and Procure-to-Pay processes. Partner with internal stakeholders and Legal, lead supplier selection and performance initiatives, manage multiple projects to meet timelines, and ensure policy compliance.

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.

The role involves programming, database development, and project management tasks in a hybrid work environment. Responsibilities include coding, documentation, unit testing, and participation in projects. The position requires working within established standards and guidelines.

Serve as a Product Owner for healthcare EDI initiatives (real-time EDI 27X required). Own and prioritize the product backlog, create business user stories, partner with Scrum Master, decompose features, ensure traceability from requirements to stories, review test acceptance criteria, support grooming/release planning, and mentor peers. Work hybrid in Arizona and deliver presentations, stakeholder communication, and project forecasting.

Support and develop EDI trading partner integrations: analyze, map, test, and troubleshoot EDI/flat-file transactions (27X, 834, 835, 837). Build SQL queries, create test files, use API testing tools, monitor production, produce reports and dashboards, maintain technical documentation, participate in projects and on-call rotation.

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.

Lead design, architecture, development and integration of complex healthcare software. Act as technical authority and program team leader, delivering requirements, coding, integrations (connectors/communications), testing, certification, verification/validation, feature definition, and customer support. Hands-on experience with QNXT required.

Review and resolve clinical and insurance inquiries by analyzing medical records, applying medical necessity and benefit criteria, documenting decisions, handling high-volume customer calls/correspondence, collaborating with internal/external stakeholders, and meeting quality, quantity, and timeliness standards while maintaining confidentiality and compliance.

Supports the Network Contracting team by assembling, verifying, and tracking provider contract and credentialing documents; manages departmental inboxes and incoming faxes; drafts contract-related correspondence; maintains databases and statistical reports for Medicaid/Medicare products; assists contract specialists with system loading and verification; identifies process gaps and coordinates with multiple departments to ensure timely, accurate contracting.

Develops, maintains, and optimizes systems, databases, ETL packages, reports, and interfaces. Writes T-SQL, SSIS, SSRS, and .NET code; troubleshoots EDI; participates in SDLC, testing, project work, documentation, and occasional SCRUM responsibilities.

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.

Manage and drive performance improvement for Medicaid managed care quality metrics (NCQA HEDIS, CMS Core). Develop and implement system-wide improvement projects and corrective action plans, analyze and report data, supervise improvement staff, collaborate across internal teams and external stakeholders (AHCCCS, providers), monitor provider performance, and ensure contractual compliance. Hybrid role requiring Arizona residency and full-time availability.

The EDI Technical Analyst develops technical documentation, analyzes and tests applications, supports end users, and manages data integration related to Trading Partner EDI and flat files.

Lead strategy, integration, and operations for the enterprise BI and data platform. Oversee ingestion, ETL, modeling, reporting, Snowflake integration, BI tool management (Business Objects, Tableau, Power BI), data governance, platform performance, and a team of data engineers and analysts to enable self-service analytics and modernization.

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.

Provide onsite primary care to clinic patients, delivering high-quality, value-based care. Evaluate and treat patients, document records, coordinate services and referrals, participate in care-team huddles, quality improvement, and community relationship-building. Maintain licensure, certifications, DEA registration, and comply with clinical policies and protocols.