SIU Case Manager USAASIU Case ManagerPhoenix, AZ$85,040–$162,550 / yearReviews investigative findings of claims identified as having confirmed elements of fraud, concealment, misrepresentation, or intentional act by evaluating the evidence to determine transfer or appropriation of claims disposition. As a dedicated SIU case manager, within defined guidelines and framework you will evaluate and conclude claims identified by SIU Investigators as having elements of fraud or an intentional act.
Claims Examiner II W. R. Berkley CorpClaims Examiner IIScottsdale, AZProactively manages claim files from inception to closure, including identification and investigation of coverage, liability and damage issues, determination and efficient execution of an appropriate plan of action, and prompt, economical file resolution, in compliance with Department guidelines and best practices. The Claims Examiner I's primary job function includes efficiently and effectively handling primarily basic third-party general liability losses in a "paperless" environment.
Executive Claims Examiner Markel Group IncExecutive Claims ExaminerScottsdale, AZ$97,520–$134,090 / yearThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist Company claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues.
Senior Disability Claims Examiner (LTD) (Virtual) Prudential Financial IncSenior Disability Claims Examiner (LTD) (Virtual)AZRemote$61,700–$101,900 / yearThe Long-Term Disability (LTD) Senior Disability Claims Examiner is responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims. Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication.
Claims Examiner I BerkleyClaims Examiner IScottsdale, ArizonaProactively manages claim files from inception to closure, including identification and investigation of coverage, liability and damage issues, determination and efficient execution of an appropriate plan of action, and prompt, economical file resolution, in compliance with Department guidelines and best practices. The Claims Examiner I’s primary job function includes efficiently and effectively handling primarily basic third-party general liability losses in a “paperless” environment.
Associate Claims Examiner, Cyber Claims Markel Group IncAssociate Claims Examiner, Cyber ClaimsScottsdale, AZ$27.84–$38.27 / hourThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Pay information: The hourly rate offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors.
Senior Claims Examiner, Medical & Healthcare Claims Markel Group IncSenior Claims Examiner, Medical & Healthcare ClaimsAZThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders.
Claims Examiner- Voluntary Benefits Accenture PlcClaims Examiner- Voluntary BenefitsScottsdale, AZAble to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills. The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions.
Senior Claims Examiner Amtrust Financial Services IncSenior Claims ExaminerScottsdale, AZ$87,600–$112,000 / yearResponsible for the prompt and efficient examination, investigation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds and claimants, ensuring that company resources are utilized in a cost effective manner in the process. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
Claims Examiner, Auto | Bodily Injury Sedgwick Claims Management Services, Inc.Claims Examiner, Auto | Bodily InjuryAZTo analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements. Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
Claims Examiner 4 Swift Transportation Co LLCClaims Examiner 4Phoenix, AZ$81,800–$117,400 / yearVolunteer opportunities to support our local communities- We have an adoration for helping others which is why we have worked hard to establish partnerships with organizations such as Children's Miracle Network and Habitat for Humanity that allow us to give back. Diversity, Equity and Inclusion - A diverse workforce allows us to achieve a dynamic business advantage where we can openly collaborate, thus bringing new ideas to the table that contribute to innovative and effective solutions.
Claims Examiner, Medical Stop Loss Crum & Forster Holdings Corp.Claims Examiner, Medical Stop LossPhoenix, AZRemoteSalary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.
Claims Examiner 5 Swift Transportation Co LLCClaims Examiner 5Phoenix, AZMake decisions and resolve conflicts in such areas as application of coverages to submitted claims, application of laws of jurisdiction to investigatory facts, application of policy exclusions and exceptions as well as the ability to read and understand contracts, hold harmless and indemnity agreements. Volunteer opportunities to support our local communities- We have an adoration for helping others which is why we have worked hard to establish partnerships with organizations such as Children's Miracle Network and Habitat for Humanity that allow us to give back.
Lead Claim Examiner I Amtrust Financial Services IncLead Claim Examiner IScottsdale, AZ$66,900–$93,000 / yearCommunicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
Claim Examiner IFG CompaniesClaim ExaminerScottsdale, AZ$80,000–$100,000 / yearThe primary role of the Claim Examiner ("CE") is to investigate, evaluate, negotiate and settle injury/damage claims in a fair and timely manner across multiple jurisdictions while applying policy coverage considerations and applicable laws and regulations. It combines a specialty-carrier focus with long-term stability and thinking, while promoting a culture of underwriting rigor, collaboration, strategic thinking, superior technology and strong producer partnerships.
Senior Auto Claim Examiner Chubb LtdSenior Auto Claim ExaminerPhoenix, AZThe company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. In this role, the person will be primarily responsible for handling Commercial Auto Claims, including property damage, property damage liability, rental management, and/or other applicable coverages.
NewSr. Manager of Medical Claims TPA Personify Health IncSr. Manager of Medical Claims TPATempe, AZ$107,000–$140,000 / yearManage regulatory and legal response: Coordinate responses to audits, legal requests, insurance complaints, Department of Labor matters, and regulatory inquiries - keeping documentation tight and timelines met. Lead and develop a claims team: Coach, guide, and hold accountable a team of examiners handling high-risk and complex claims - driving performance, engagement, and results through active feedback and talent development.
Claims Support Specialist, Medical Stop Loss Hybrid Crum & Forster Holdings Corp.Claims Support Specialist, Medical Stop Loss HybridScottsdale, AZRemoteWe believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community. Information about the Role, Line of Business and Team: The role of Claims Support Specialist is a unique opportunity to work with a high-quality team of leaders and benefit from the security and stability of a large organization while maintaining a nimble and responsive approach to business.
Claims Support Specialist, Medical Stop Loss - Hybrid Crum & ForsterClaims Support Specialist, Medical Stop Loss - HybridScottsdale, ArizonaRemoteWith our employee-first focus, the Company is consistently recognized as a great place to work, earning multiple workplace and wellness awards, including the Great Place to Work® Award, Fortune 100 Best Companies to Work For, Fortune Best Workplaces for Parents, Fortune Best Workplaces for Millennials, and many others. We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.
Senior Construction Defect Technical Claims Specialist Argo Group International Holdings IncSenior Construction Defect Technical Claims SpecialistAZRemote$137,496–$164,934 / yearBoston metro area, California outside of Los Angeles & San Francisco metro area, Connecticut, Chicago metro area, Denver metro area, New Jersey (outside of New York City metro area), New York State (outside of New York City metro area, including but limited to Albany county), Washington, D. C. Essential Responsibilities: Working under limited oversight under broad management direction, adjudicate construction defect claims at the highest authority limits on assignments reflecting the highest degree of technical complexity, potentially with major impact on departmental results.
NewClaims Customer Service Supervisor Arizona Priority CareClaims Customer Service SupervisorChandler, ArizonaAs a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers.
Claims Team Lead, Auto Sedgwick Claims Management Services, Inc.Claims Team Lead, AutoAZPRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Skills & knowledge: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, leadership/management skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies.
NewClaims Director-Commercial Direct Handle Chubb LtdClaims Director-Commercial Direct HandlePhoenix, AZSuccessful professionals at Chubb come from many backgrounds with experiences rich in diversity that they bring with them to our company along with: an inclusive mindset which allows differences to be leveraged for better business results; open, transparent communication; teamwork and inclusion which draws on diverse ideas and perspectives; and. Seven or more years of experience as a casualty claim professional with a high degree of specialized and technical competence in the handling of high exposure construction claims with emphasis on hands-on file and litigation management.
Senior Claims Specialist I, Workers Compensation - West Region Liberty Mutual Holding Company IncSenior Claims Specialist I, Workers Compensation - West RegionScottsdale, AZRemoteResponsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state s tort laws as normally acquired through a bachelor s degree (or equivalent training) plus 3 to 5 years directly related work experience.
Claims Specialist, Workers Compensation - West Region Liberty Mutual Holding Company IncClaims Specialist, Workers Compensation - West RegionPhoenix, AZRemoteResponsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits.
Senior Claim Technical Specialist IFG CompaniesSenior Claim Technical SpecialistScottsdale, AZ$110,000–$120,000 / yearThe Senior Claim Technical Specialist ("SCTS") is a high-impact role focused on investigating, evaluating, negotiating and settling serious injury/damage claims involving complex coverage and large loss exposures in multiple jurisdictions. It combines a specialty-carrier focus with long-term stability and thinking, while promoting a culture of underwriting rigor, collaboration, strategic thinking, superior technology and strong producer partnerships.
Examiner Nurse Practitioner Loyal Source Government Services LLCExaminer Nurse PractitionerPeoria, AZ$138,923–$168,923 / yearThe role involves reviewing the claim, performing focused assessments of claimed injuries, reviewing medical records, and potentially rendering a medical opinion based on the record review and completed Compensation & Pension (C&P) exam. Job Responsibilities: Conduct Comprehensive Medical Disability Examinations: Perform thorough and focused medical evaluations of Veterans, including reviewing their medical history, conducting physical examinations, and assessing the impact of disabilities on their daily life and functional abilities.
EDI Technical Analyst (Claims) - Hybrid Blue Cross Blue Shield of ArizonaEDI Technical Analyst (Claims) - HybridPhoenix, ArizonaDevelops technical documentation, designs, analyzes, tests, provides end user support and training for new applications and data structures; and provides post-implementation review for systems and reporting to support customers and management. 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.
NewClaims Processor (remote) Iowa ONLY Cognizant Technology Solutions CorpClaims Processor (remote) Iowa ONLYPhoenix, AZRemoteBy clicking "Accept All", you agree to the storing of cookies on your device to give you the most optimal experience using our website. We may also use cookies to enhance performance, analyse site usage and to personalise your experience.
Injury Examiner USAAInjury ExaminerPhoenix, AZ$85,040–$162,550 / yearAs a dedicated Injury Examiner, you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.
Examiner Physician Assistant Loyal Source Government Services LLCExaminer Physician AssistantPeoria, AZ$138,923–$168,923 / yearThe role involves reviewing the claim, performing focused assessments of claimed injuries, reviewing medical records, and potentially rendering a medical opinion based on the record review and completed Compensation & Pension (C&P) exam. About Loyal Source Loyal Source is an Orlando-based workforce solutions provider dedicated to delivering elite services worldwide, with a focus in government healthcare, technical and support services, engineering, and travel healthcare.
Auto Claim Specialist Chubb LtdAuto Claim SpecialistPhoenix, AZThe company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. Position Overview: The Claim Specialist (Commercial) is responsible for handling Commercial Auto Claims, including property damage, property damage liability, rental management, and other applicable coverages.
EDI Technical Analyst (Claims) - Hybrid Blue Cross and Blue Shield AssociationEDI Technical Analyst (Claims) - HybridPhoenix, AZLevel 2-4)2 years of EDI experience (Level 1)Required EducationHigh-School Diploma or GED in general field of study (All Levels)Required LicensesN/ARequired CertificationsN/APREFERRED QUALIFICATIONSPreferred Work Experience2 years of experience in computer technology and/or information systems (Level 1 -2)2 years of experience working in healthcare-related systems as a business / systems analyst or programmer (All Lev)2 years of experience with 27X, 834, 835 and 837.5 years of experience in data analysis, management, integration and reporting (Levels 3 - 4)3 years of experience working in corporate enterprise-level systems as a business or systems analyst or programmer (Levels 3 - 4)Preferred EducationBachelor's Degree in Computer Science, Information Systems, Business, or related field (All Levels)Preferred LicensesN/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIESLevel 1 - Entry-level role; Performs job functions under close supervision or peer reviewPRODUCTION SUPPORTTrack and resolve basic or routine processing problems, coordinating with all areas. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per weekHybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per weekHybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per monthOnsite: daily onsite requirement based on the essential functions of the jobRemote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team buildingPlease note that onsite requirements may change in the future, based on business need, and job responsibilities.
Finance Product Owner-Velocity Claim Payment Operations- Remote AZ Blue Cross Blue Shield of ArizonaFinance Product Owner-Velocity Claim Payment Operations- Remote AZPhoenix, ArizonaRemoteAZ 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. Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistAZ$17–$31.30 / hourThe candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns. CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department.
Finance Product Owner-Velocity Claim Payment Operations- Remote AZ Blue Cross and Blue Shield AssociationFinance Product Owner-Velocity Claim Payment Operations- Remote AZPhoenix, AZRemoteAZ 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. Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building.
Medical Director (Remote) Securian Financial Group, Inc.Medical Director (Remote)AZRemote$211,000–$287,000 / yearProvide decisions for UW and claims based on solid medical knowledge consistent with current guidelines, demonstrate ability to incorporate new medical knowledge into guideline updates and enhancements, includes advanced proficiency in ECG interpretation. In this role, you will integrate evidence-based medical knowledge with insurance principles to assess mortality and morbidity risk, influence underwriting decisions, evaluate claims, and shape forward-looking risk management strategies.
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)AZ$46,988–$122,400 / yearDemonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)AZ$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
New(USA) Operations Manager, Asset Protection - DC/FC Walmart Inc(USA) Operations Manager, Asset Protection - DC/FCGLENDALE, AZ$84,000–$126,000 / yearData and Digital Literacy Possesses knowledge of Data collection modes techniques and tools data analytics and data visualization tools and techniques existing and upcoming digital applications and systems technology innovation trends and industry benchmarks and data governance To be able to carry out the following responsibilities Identifies problems leverages data to determine root causes and applies information to find solutions Participates in the feedback loop between data intake and insights and works to improve the datacollection process Articulates the levers that influence data Ensures data quality and organizes processes information for analysis Leverages visualization techniques and tools to create dashboards for stakeholders and leadership Identifies and propose ways to automateimprove existing processes in assigned respective area of work with the help of technology for example RPA artificial intelligence machine learning Documents business requirements for new technology solutions Develops tests and integrates prototypes to support the creation of technologyenabled solutions Develops and implements technology changes across multiple processes within assigned area of work. Asset Protection Training Delivery Possesses knowledge of Training methodologies training content development processes organizational training lifecycles To be able to carry out the following responsibilities Participates in delivering training content from existing training plans Interprets basic dos and donts for different training delivery mediums Creates learning objectives while managing participant questions and concerns Addresses unique techniques for preparing course material and delivering instructions Assists in the delivery and evaluation of training program components Educates contractors on relevant lawscompany policies involving the negotiation and signing of contracts.
Optometrist US Department of Health and Human ServicesOptometristKayenta, AZMENU Sign in My jobs Profile Resumes & documents Search preferences Notifications Sign out My jobs Profile Resumes & documents Notifications Search preferences Sign out Events Help Center Search Back to results Apply Optometrist Department of Health and Human Services Indian Health Service Various locations across the Agency Apply Print Save. Licensure: Applicants must have received a passing score on the National Board of Examiners in Optometry NBEO examinations and possess a current full and unrestricted license to practice optometry in a State the District of Columbia the Commonwealth of Puerto Rico or a territory of the United States.
NewAppeal and Grievance Coordination Research Reviewer - HYBRID Blue Cross Blue Shield of ArizonaAppeal and Grievance Coordination Research Reviewer - HYBRIDPhoenix, ArizonaRemote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building. 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.
Medical Appeals and Grievance (MAG) Registered Nurse Specialist II Blue Cross Blue Shield of ArizonaMedical Appeals and Grievance (MAG) Registered Nurse Specialist IIPhoenix, ArizonaRemoteDemonstrate ability to acquire specialized knowledge to complete all types of level one appeals, grievances and corrected claims for local lines of business using appropriate benefit plan booklet, administrative guidelines and policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research and precertification research. Ability to demonstrate specialized knowledge to administer Federal Employee Program (FEP)inquiries, appeals, grievances and sub-reconsiderations using appropriate service benefit plan provisions, and internal policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research, and precertification research.
Financial Technical Analyst III - Hybrid Blue Cross Blue Shield of ArizonaFinancial Technical Analyst III - HybridPhoenix, Arizona8 years of experience supporting technical workflows related to cash processing, 1099s, Medical Loss Ratio, claims payments, invoicing, and premium payments including Ebox, Lockbox, IVR, and autopay channels. REQUIREMENTS: Bachelor’s degree or equivalent in Accounting, Business Information Systems, Computer Science, Mathematics, or related field of study and 8 years of progressive experience as a financial analyst with experience in system configuration, reporting, and integrations.
CAPS - BC Home - Hybrid 2 Blue Cross Blue Shield of ArizonaCAPS - BC Home - Hybrid 2Phoenix, ArizonaRemoteAZ 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. Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
Business Intelligence Developer-Medicaid - Level I (Remote AZ) Blue Cross Blue Shield of ArizonaBusiness Intelligence Developer-Medicaid - Level I (Remote AZ)Phoenix, ArizonaRemoteThis position partners with business leaders across the organization to provide high quality reporting and analysis that is accurate, thoroughly researched, assists in identifying risks & opportunities, and provides untapped insights and knowledge to enable data driven and data literate decision making for departments and teams throughout the entire Medicaid segment. The Business Intelligence Developer - Medicaid role is responsible for the design, creation, and maintenance of sustainable reporting solutions and analytical insights that improve efficiency, drive innovation, and inform data driven decision making in support of broader business and corporate strategies across the organization.
High-Cost Claimant Review Unit Nurse Auditor (Remote in AZ) Blue Cross Blue Shield of ArizonaHigh-Cost Claimant Review Unit Nurse Auditor (Remote in AZ)Phoenix, ArizonaRemotePrimary responsibilities include: Function as a designated clinical resource to review High Cost Claimants to identify opportunities to improve member outcomes and determine correct utilization of resources. 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.
Sr. Mgr - Data Platform, Business Intelligence - Hybrid Blue Cross Blue Shield of ArizonaSr. Mgr - Data Platform, Business Intelligence - HybridPhoenix, ArizonaThis leader manages data engineers, analysts, and technical leads, drives Snowflake integration and ETL development, and enables self-service analytics capabilities while maintaining strong data governance and integrity. 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.
Procurement - Category Lead - HYBRID Blue Cross Blue Shield of ArizonaProcurement - Category Lead - HYBRIDPhoenix, ArizonaDevelop category and market expertise that allows the organization to effectively compete in target market segments; this includes market trends and competitive analysis, as inputs to the development of our assortment strategy. Manage and maintain, based on business segment requirements, supplier/vendor categories, support business case development for on-going business needs and projects, and ensure strategic sourcing initiatives are embraced.
Competitive Intelligence Analyst III - Hybrid Blue Cross Blue Shield of ArizonaCompetitive Intelligence Analyst III - HybridPhoenix, ArizonaThe Competitive Intelligence Analyst scopes and completes research and reporting projects at the direction of the Strategic Intelligence Department, from requests occurring from a variety of sources within the organization including but not limited to: Executive management, Corporate Strategy, Growth Division,, Marketing, Product Development, and Actuarial Services. In support to the Director of Strategic Intelligence engage in assigned projects or reporting assignments by defining research and intelligence objectives, including identification of appropriate research methodologies, report/deliverable outcomes, reporting formats and communication requirements.